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Washington rates for HCPCS A4391

Ostomy Pouch Urinary With Extended Wear Barrier Attached (1 Piece) Each (Updated 01-01-2003) Ch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.60 / $12.71 / $13.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $5.60 / $13.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.65 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.01 / $8.72 / $49.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.98
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $9.99 / $17.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $10.07 / $17.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.82 / $7.58 / $8.33
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.85 / $9.64 / $9.86
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.85 / $9.86 / $9.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.19 / $8.65 / $15.98
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $9.35 / $14.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.85 / $8.39 / $10.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $4.19 / $7.99
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $5.78 / $5.78