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Utah rates for HCPCS A4390

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

Facilitymedian $3 · 10th–90th $3$80%50%90th$3Professionalmedian $10 · 10th–90th $3$590%10%10th90th$10$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
Setting
Facility
Modifier
Global
Typical Low
$3.02
Median
$3.02
Typical High
$3.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$8.71
Typical High
$58.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$9.55
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$9.77
Typical High
$13.18
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$9.55
Median
$9.55
Typical High
$15.14
Select Health
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$13.49
Typical High
$13.80
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$13.80
Typical High
$16.60
United
Setting
Facility
Modifier
Global
Typical Low
$4.47
Median
$5.13
Typical High
$5.25
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$5.75
Typical High
$10.23