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Utah rates for HCPCS A5054

Ostomy Pouch Closed; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) M: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.34 / $7.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $3.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $1.83 / $2.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.76 / $2.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.07 / $1.25