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Utah rates for HCPCS A6025

Gel Sheet For Dermal Or Epidermal Application (E.G. Silicone Hydrogel Other) Each. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $7.51 / $7.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.51 / $9.96 / $23.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.47 / $13.47 / $13.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.84 / $17.84 / $17.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.64 / $10.61 / $17.67