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Utah rates for HCPCS A4364

Adhesive, liquid or equal, any type, per oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $2.45 / $10.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.35 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.88 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.75 / $2.34