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Utah rates for HCPCS A6221

Gauze, nonimpregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.80 / $2.80 / $2.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00