go back

Utah rates for HCPCS A6258

Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $3.61 / $17.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.07 / $3.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $4.91 / $30.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $4.21 / $4.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.54 / $3.66