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Utah rates for HCPCS A4387

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.50 / $9.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $3.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $2.29 / $3.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.20 / $3.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.33 / $2.58