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Washington 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
$1.12 / $2.57 / $2.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.12 / $2.68
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.74 / $12.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $2.90 / $4.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $2.90 / $4.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.68 / $1.68
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $1.80 / $1.99
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.99 / $1.99
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.74 / $3.22
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.94 / $2.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.69 / $1.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.99 / $1.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $1.69