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Utah rates for HCPCS A4428

Ostomy Pouch Urinary With Extended Wear Barrier Attached With Faucet-Type Tap With Valve (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $4.86 / $26.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $10.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $6.65 / $8.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.05 / $6.38 / $9.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $3.86 / $4.54