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Utah rates for HCPCS A4396

Ostomy belt with peristomal hernia support

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $36.31 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $33.88 / $33.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $39.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $41.69 / $53.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $40.74 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $56.23 / $57.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $57.54 / $69.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $21.88 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $23.99 / $34.67