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Utah rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.81 / $769.81 / $769.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $729.99 / $829.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$838.13 / $1,134.42 / $1,304.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
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
$656.99 / $729.99 / $729.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63