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Utah rates for HCPCS A4388

Ostomy pouch, drainable, with extended wear barrier attached, (one piece), 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
$3.63 / $4.47 / $6.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $4.37 / $6.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $6.03 / $6.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.17 / $7.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.34 / $2.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.57 / $3.72