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Utah rates for HCPCS A4217

Sterile water/saline, 500 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $19.95 / $32.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $5.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $3.02 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.63 / $2.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.80 / $3.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.80 / $4.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.86 / $2.63