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Utah rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $7.94 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $9.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $9.77 / $13.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $9.55 / $14.45
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.49 / $13.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.80 / $16.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $5.13 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $5.75 / $8.13