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Utah rates for HCPCS A5105

Urinary suspensory with leg bag, with or without tube, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $36.31 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $66.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.30 / $38.02 / $51.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $37.15 / $54.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $51.29 / $57.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $52.48 / $69.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $21.88 / $22.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $23.99 / $34.67