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Utah rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.11 / $104.11 / $104.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $98.72 / $112.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.88 / $96.96 / $111.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $89.75
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
$88.85 / $98.72 / $98.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $89.75