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Utah rates for HCPCS A4626

Tracheostomy cleaning brush, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $16.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $3.24 / $4.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $3.16 / $4.27
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $4.47 / $4.57
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $4.57 / $4.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.74 / $3.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.91 / $2.69