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Utah rates for HCPCS A5071

Ostomy pouch, urinary; with barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $5.01 / $36.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $4.27 / $5.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $6.17 / $9.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $6.03 / $8.91
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $8.32 / $8.51
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $8.51 / $10.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $3.24 / $3.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $3.55 / $5.13