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Utah rates for HCPCS A4400

Ostomy Irrigation Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.69 / $18.69 / $18.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.69 / $33.75 / $197.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.02 / $41.02 / $41.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.86 / $34.86 / $79.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.67 / $47.02 / $61.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.81 / $45.09 / $67.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.67 / $28.35 / $32.40