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Utah rates for HCPCS A6021

Collagen Dressing Sterile Size 16 Sq. In. Or Less Each (Revised 01/01/13)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.03 / $8.03 / $8.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.03 / $16.64 / $84.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.07 / $23.89 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.32 / $20.57 / $20.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.76 / $12.46 / $14.98