go back

Utah rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.26 / $88.26 / $88.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $83.70 / $95.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.47 / $112.31 / $152.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
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
$75.33 / $83.70 / $83.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09