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Utah rates for HCPCS A5093

Ostomy Accessory; Convex Insert (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $1.46 / $7.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.64 / $3.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.99 / $2.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.91 / $2.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.15 / $1.15