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Utah rates for HCPCS A4411

Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $3.98 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $4.27 / $4.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $5.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $5.25 / $7.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.13 / $7.59
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.08 / $7.24
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $7.24 / $8.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $2.75 / $3.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $3.02 / $4.37