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Utah rates for HCPCS A4378

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.76 / $11.76 / $11.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.76 / $22.90 / $123.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.81 / $25.81 / $25.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $25.81 / $49.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.46 / $31.36 / $40.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.88 / $30.07 / $45.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.90 / $18.22 / $19.82