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Utah rates for HCPCS A5105

Urinary Suspensory; With Or Without Leg Bag With Or Without Tube Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.59 / $15.59 / $15.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.59 / $28.85 / $164.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $23.24 / $66.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.83 / $37.97 / $49.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.83 / $36.28 / $54.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $24.16 / $24.16