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Utah rates for HCPCS A4433

Ostomy pouch, urinary; for use on barrier with locking flange (two piece), 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 / $3.02 / $20.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $3.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $3.39 / $4.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.39 / $5.01
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $4.79
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $4.79 / $5.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $1.82 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $2.00 / $2.82