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Washington rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $3.02 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $4.47
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $7.08 / $12.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $7.59 / $12.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.57 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.89 / $6.03
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.03 / $6.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.25 / $9.77
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $6.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $5.25 / $6.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $2.29 / $2.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.51 / $4.79
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $5.25 / $9.12