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Washington rates for HCPCS A4363

Ostomy clamp, any type, replacement only, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.88 / $4.26 / $4.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.88 / $4.50
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.90 / $19.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $1.99 / $2.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $2.27
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $3.31 / $5.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $3.31 / $5.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.28 / $2.54 / $2.79
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.96 / $3.16 / $3.31
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $3.31 / $3.31
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.90 / $6.62
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.99 / $4.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $3.23 / $3.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.81 / $3.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.51 / $2.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $4.45 / $4.45