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Utah rates for HCPCS A4414

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 in or smaller, 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 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $3.55 / $4.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $5.01 / $6.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $4.90 / $7.41
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.92 / $7.08
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.08 / $8.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.63 / $2.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.95 / $4.17