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Utah rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $6 · 10th–90th $6–$160%50%90th$6Professionalmedian $17 · 10th–90th $6–$1050%10%10th90th$17$0.2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $15.49 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $13.49 / $15.85
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $17.38 / $23.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $16.98 / $26.92
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $23.99 / $24.55
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $24.55 / $29.51
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $9.33 / $10.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $10.23 / $18.20