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Utah rates for HCPCS A4357

Bedside drainage bag, day or night, with or without antireflux device, with or without tube, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.72 / $8.32 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $9.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $8.51 / $32.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $8.32 / $12.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $11.48 / $13.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $11.75 / $14.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.25 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $5.75 / $8.32