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Utah rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,221.34 / $1,221.34 / $1,221.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,158.18 / $1,316.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.74 / $396.47 / $714.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
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
$1,042.35 / $1,158.18 / $1,158.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89