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Utah rates for HCPCS 96522

Refill&Maintenance Pump Drug Dlvr Systemic

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.91 / $135.12 / $193.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.76 / $158.44 / $247.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.77 / $86.94 / $115.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.03 / $175.62 / $199.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.50 / $135.24 / $204.76