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Utah rates for HCPCS A6403

Gauze Non-Impregnated Sterile Pad Size More Than 16 Sq. In. Less Than Or Equal To 48 Sq. In. Without Adhesive Border Each Dressing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.17 / $0.17 / $0.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.17 / $0.34 / $1.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.29 / $0.42 / $0.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.40 / $0.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.25 / $0.28