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Washington rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Facilitymedian $9 · 10th–90th $5$170%20%10th90th$9Professionalmedian $6 · 10th–90th $3$130%10%10th90th$6$0.1$0.5$2.0$10.0$50.0

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
$3.98 / $3.98 / $11.75
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $5.01 / $10.96
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.59 / $7.59 / $7.59
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.59 / $7.59 / $9.77
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.25 / $5.62 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $4.47 / $5.62
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.25 / $10.47 / $18.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.25 / $10.96 / $18.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.61 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.76 / $8.51 / $8.71
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.76 / $8.71 / $9.55
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.24 / $7.59 / $14.13
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.24 / $7.24 / $8.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.59 / $9.77
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.39 / $3.98 / $5.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.39 / $3.89 / $7.08
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.13 / $7.59 / $13.18