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Utah rates for HCPCS Q4257

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,061.50 / $1,061.50 / $1,061.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $1,006.60 / $1,143.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.54 / $706.47 / $915.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.94 / $1,006.60 / $1,006.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09