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Utah rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.67 / $0.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.67 / $1.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.76 / $2.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.69 / $2.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.01 / $1.20