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Utah rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.82 / $2.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.78 / $2.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.51 / $2.57
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.57 / $3.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.98 / $1.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.07 / $1.51