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Utah rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $4.46 / $24.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $5.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.03 / $9.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $6.12 / $7.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.66 / $5.87 / $8.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $3.55 / $4.17