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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 / $35.43 / $191.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.94 / $39.94 / $39.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.95 / $39.94 / $77.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.66 / $48.53 / $63.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.97 / $46.54 / $69.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.51 / $28.19 / $33.11