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Utah rates for HCPCS A6455

Self-adherent bandage, elastic, nonknitted/nonwoven, width greater than or equal to 5 in, per yd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $1.17 / $5.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.75 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.37 / $1.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.83 / $1.18