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Utah rates for HCPCS A4376

Ostomy pouch, drainable, with faceplate attached, rubber, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $42.66 / $288.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $46.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $48.98 / $63.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $47.86 / $70.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $66.07 / $67.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $67.61 / $81.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $25.70 / $28.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $28.18 / $40.74