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Utah rates for HCPCS Q4204

Xwrap 1 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,282.88 / $4,282.88 / $4,282.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $4,061.36 / $4,615.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,412.58 / $3,692.14 / $6,968.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
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
$3,655.22 / $4,061.36 / $4,061.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14