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Utah rates for HCPCS Q4208

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.40 / $398.40 / $398.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.80 / $398.40 / $412.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00