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Utah rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $1.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $2.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.52 / $1.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.46 / $2.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.88 / $1.04