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Utah rates for HCPCS A4357

Bedside Drainage Bag Day Or Night With Or Without Anti-Reflux Device With Or Without Tube Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.71 / $3.71 / $3.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.71 / $7.47 / $39.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.40 / $8.15 / $8.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.93 / $8.15 / $15.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $8.42 / $10.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $8.07 / $12.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $5.63 / $6.44