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Utah rates for HCPCS A4455

Adhesive remover or solvent (for tape, cement or other adhesive), per oz

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.55 / $2.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.23 / $1.41
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $3.63
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.78 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.85 / $1.23