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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
$3.68 / $3.68 / $3.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $7.15 / $38.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $15.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $9.78 / $12.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $9.39 / $14.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $5.69 / $6.84