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Utah rates for HCPCS A4623

Tracheostomy Inner Cannula. (Rvsd 1/1/04) Ecial Coverage Instructions Apply. See Cim: 65-16)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.86 / $22.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $6.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $5.50 / $10.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $5.69 / $7.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $5.45 / $8.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.96 / $3.88 / $5.57