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Utah rates for HCPCS A5122

Skin Barrier; Solid 8 X 8 Or Equivalent Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.91 / $4.91 / $4.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.91 / $9.56 / $51.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.78 / $10.78 / $10.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.16 / $10.78 / $20.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.70 / $13.10 / $17.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.94 / $12.52 / $18.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.96 / $7.61 / $8.93