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Utah rates for HCPCS A6209

Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $6.76 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $9.33 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $7.41 / $7.41
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $10.47 / $10.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $10.72 / $12.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.47 / $6.31