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Utah rates for HCPCS A4375

Ostomy Pouch Drainable With Faceplate Attached Plastic Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $6.57 / $6.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.57 / $12.79 / $69.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $16.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.35 / $17.51 / $22.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.35 / $16.79 / $25.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $10.18 / $11.95