go back

Utah rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.01 / $82.01 / $82.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $77.06 / $88.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.98 / $95.94 / $174.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
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
$69.98 / $77.77 / $77.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70