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Utah rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.00 / $996.00 / $996.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$972.00 / $996.00 / $1,032.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $788.99