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Utah rates for HCPCS A4398

Ostomy Irrigation Supply; Bag Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.28 / $5.28 / $5.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.28 / $10.29 / $55.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.60 / $11.60 / $14.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.86 / $11.60 / $22.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.56 / $14.15 / $19.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.74 / $13.52 / $20.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $8.19 / $9.61