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Utah 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
$0.55 / $0.55 / $0.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $1.10 / $5.76
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 / $1.42 / $1.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.21 / $1.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.85 / $1.28