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Utah rates for HCPCS A5122

Skin barrier; solid, 8 x 8 or equivalent, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $10.96 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $10.72 / $10.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $12.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.18 / $20.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.88 / $16.98
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $17.78 / $18.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $18.20 / $18.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.92 / $7.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.59 / $10.96