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Utah rates for HCPCS A5131

Appliance cleaner, incontinence and ostomy appliances, per 16 oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $14.13 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $16.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $16.22 / $21.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $15.85 / $20.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $22.39 / $22.39
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $22.39 / $22.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $8.51 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $9.33 / $13.49