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Utah rates for HCPCS A4381

Ostomy pouch, urinary, 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 / $3.98 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3.89 / $3.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.31 / $4.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.68 / $6.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $4.57 / $6.92
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $6.46 / $6.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $6.61 / $7.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.51 / $2.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.75 / $3.89