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Utah rates for HCPCS Q4175

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.19 / $106.19 / $106.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $100.69 / $114.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.77 / $91.54 / $104.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.62 / $100.69 / $100.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54