go back

Utah rates for HCPCS A4389

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

Facilitymedian $2 · 10th–90th $2–$50%50%90th$2Professionalmedian $6 · 10th–90th $2–$380%10%10th90th$6$0.1$0.5$2.0$10.0$50.0

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 / $5.62 / $38.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.25 / $5.25 / $5.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $4.47 / $6.17
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $6.31 / $8.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $9.77
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $8.71 / $8.91
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.61 / $8.91 / $10.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.95 / $3.39 / $4.37
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.88 / $3.72 / $6.61