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Utah rates for HCPCS A4223

Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $18.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $45.00 / $60.00