go back

Michigan rates for HCPCS A4455

Adhesive Remover Or Solvent (For Tape Cement Or Other Adhesive) Per Ounce (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.26 / $1.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $6.00 / $11.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.06 / $2.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $2.34
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.51 / $7.51
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.45 / $2.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.94 / $1.46