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Utah rates for HCPCS A5063

Ostomy pouch, drainable; for use on barrier with flange (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $16.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $2.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.75 / $4.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.69 / $4.07
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.80 / $3.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.89 / $4.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.45 / $1.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.58 / $2.29