go back

Utah rates for HCPCS Q4191

Restorigin, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.15 / $760.15 / $760.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $720.83 / $819.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.36 / $1,342.31 / $2,236.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
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
$648.75 / $720.83 / $720.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29