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Washington rates for HCPCS A4390

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

Facilitymedian $13 · 10th–90th $8$250%20%10th90th$13Professionalmedian $9 · 10th–90th $5$190%10%10th90th$9$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
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$18.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$3.02
Median
$7.59
Typical High
$18.20
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$11.75
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$11.75
Median
$11.75
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.51
Typical High
$8.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.51
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$16.60
Typical High
$27.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$8.13
Median
$16.98
Typical High
$28.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$9.33
Median
$10.23
Typical High
$64.57
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$13.18
Typical High
$13.49
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$13.49
Typical High
$13.49
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$11.22
Median
$11.75
Typical High
$21.88
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$11.22
Typical High
$13.18
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$11.75
Typical High
$15.14
United
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$5.75
Typical High
$8.71
United
Setting
Professional
Modifier
Global
Typical Low
$5.25
Median
$6.03
Typical High
$10.96
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$7.94
Median
$11.75
Typical High
$20.42