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Utah rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Facilitymedian $2 · 10th–90th $1–$20%50%10th$2Professionalmedian $2 · 10th–90th $2–$140%20%40%10th90th$2$0.1$0.2$1.0$5.0$20.0

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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $13.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.62 / $1.62 / $2.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.86 / $2.29 / $3.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.24 / $2.24 / $3.55
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.16 / $3.16 / $3.24
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.40 / $3.24 / $3.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.07 / $1.20 / $1.32
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.05 / $1.32 / $3.16