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Utah rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.61 / $113.61 / $113.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $113.61 / $367.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.71 / $135.76 / $156.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
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
$96.96 / $107.73 / $151.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94