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Washington rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $24 · 10th–90th $14$460%20%10th90th$24Professionalmedian $17 · 10th–90th $10$340%10%10th90th$17$0.2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $32.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $13.49 / $32.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $20.89
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $26.92
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $15.85 / $15.85
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $13.49 / $15.85
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $28.18 / $48.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $30.90 / $48.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.60 / $18.20 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.38 / $23.44 / $23.99
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $23.99 / $26.30
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $20.89 / $38.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $23.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $20.89 / $26.92
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $10.23 / $15.85
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $10.72 / $19.50
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $20.89 / $36.31