go back

Washington rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.94 / $18.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $8.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $15.85 / $27.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $17.38 / $28.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $10.23 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $13.18 / $13.49
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $13.49 / $13.49
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $11.75 / $21.88
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $14.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $11.75 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $5.13 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.75 / $10.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $11.75 / $20.42