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Utah rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $33.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $5.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $5.62 / $7.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $5.50 / $8.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $7.76 / $7.76
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $7.76 / $9.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $2.95 / $3.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.24 / $4.68