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Utah rates for HCPCS C9285

Lidocaine 70 mg/tetracaine 70 mg, per patch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $15.85 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $17.38 / $17.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $17.38 / $17.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $30.20 / $75.86
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $18.20 / $18.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.42 / $20.42