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Utah rates for HCPCS A4389

Ostomy Pouch Drainable 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
$2.38 / $2.38 / $2.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $4.63 / $25.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $10.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $6.33 / $8.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.83 / $6.07 / $9.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $3.61 / $4.32