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Utah rates for HCPCS A4257

Replacement lens shield cartridge for use with laser skin piercing device, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $10.70 / $51.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $7.28 / $7.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.49 / $15.84 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $17.41 / $17.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.91 / $12.48 / $12.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $7.56 / $10.19