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Utah rates for HCPCS A4431

Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.38 / $2.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $4.63 / $25.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.59 / $5.59 / $5.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.75 / $5.59 / $6.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.19 / $6.33 / $8.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.83 / $6.07 / $9.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $3.68 / $4.32