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Washington rates for HCPCS A4387

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $4.04 / $4.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.00 / $4.26
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $90.00 / $90.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.81 / $15.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.33
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $3.27 / $5.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $3.56 / $5.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.40 / $2.64
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.83 / $3.14 / $4.75
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $3.14 / $4.75
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $2.75 / $5.09
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.98 / $4.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.67 / $3.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.22 / $2.58
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $3.28 / $3.28