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Utah rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $1.07 / $5.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $2.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.32 / $1.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.27 / $1.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.85 / $1.00