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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
$1.64 / $1.64 / $1.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $3.19 / $17.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $7.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $4.37 / $5.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $4.19 / $6.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.54 / $2.98