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Utah rates for HCPCS A4367

Ostomy Belt Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.81 / $2.81 / $2.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $5.48 / $28.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.18 / $6.18 / $6.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.18 / $12.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.89 / $7.53 / $9.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.71 / $7.20 / $10.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $4.36 / $4.36