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Utah rates for HCPCS A4435

Ostomy Pouch Drainable High Output With Extended Wear Barrier(One-Piece System) With Or Without Filter Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $2.93 / $2.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.93 / $4.29 / $23.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $4.84 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.84 / $9.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.82 / $5.88 / $7.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $5.64 / $8.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $3.42 / $4.01