go back

Utah rates for HCPCS Q4173

PalinGen or PalinGen XPlus, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.86 / $404.86 / $404.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $383.92 / $436.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.01 / $514.57 / $857.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.01 / $349.01 / $349.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.53 / $383.92 / $383.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $349.02