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Utah rates for HCPCS A4680

Activated carbon filter, ea

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.54 / $20.54 / $20.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.54 / $26.02 / $45.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $36.29 / $36.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $127.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.05 / $48.05 / $48.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.89 / $28.58 / $48.33