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Montana 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
Professional
Modifier
Low / Median / High Price
$0.59 / $0.60 / $5.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.69 / $1.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $1.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.82 / $1.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.73 / $1.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.49 / $2.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $0.85 / $0.97