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Utah rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $3.02 / $26.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $4.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $4.37 / $5.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $4.27 / $6.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $6.03 / $6.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $6.17 / $7.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.29 / $2.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.51 / $3.63