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Utah rates for HCPCS A4354

Insertion Tray With Drainage Bag But Without Catheter (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.51 / $4.51 / $4.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.51 / $9.90 / $47.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.42 / $8.42 / $8.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.21 / $11.40 / $30.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.80 / $9.82 / $9.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.48 / $6.99 / $10.02