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Utah rates for HCPCS A5073

Ostomy pouch, urinary; for use on barrier with flange (two piece), 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 / $19.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $3.16 / $5.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $3.09 / $4.47
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.37 / $4.47
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $4.47 / $5.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.70 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.86 / $2.69