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Utah rates for HCPCS A5072

Ostomy Pouch Urinary; Without Barrier Attached (1piece) Each (Updated 01-01-2003) 30)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $2.63 / $14.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $2.86 / $2.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.43 / $3.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.55 / $3.14 / $4.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $3.00 / $4.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $2.09 / $2.09