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Utah rates for HCPCS A5063

Ostomy Pouch Drainable; For Use On Barrier With Flange (2 Piece System) Each Ly. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.18 / $10.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.27 / $4.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $2.76 / $3.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.65 / $3.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.60 / $2.84