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Utah rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Facilitymedian $1 · 10th–90th $1–$20%50%90th$1Professionalmedian $3 · 10th–90th $1–$170%10%20%10th90th$3$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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $2.00 / $16.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.29 / $2.29 / $2.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.95 / $1.95 / $2.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.29 / $2.82 / $3.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.75 / $2.75 / $4.37
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.55 / $3.89 / $3.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.95 / $3.89 / $4.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $1.48 / $1.51
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.29 / $1.62 / $2.95