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Utah rates for HCPCS A4393

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

Facilitymedian $3 · 10th–90th $3–$80%50%90th$3Professionalmedian $9 · 10th–90th $3–$550%10%10th90th$9$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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.02 / $8.13 / $54.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.46 / $6.46 / $8.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.46 / $9.12 / $12.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $9.12 / $14.13
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $12.59 / $12.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.55 / $12.88 / $15.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.27 / $4.90 / $6.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.17 / $5.37 / $9.55