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Washington rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Facilitymedian $10 · 10th–90th $6$190%20%10th90th$10Professionalmedian $7 · 10th–90th $4$140%10%10th90th$7$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
$5.01 / $5.01 / $13.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $5.01 / $12.88
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.51 / $8.51 / $8.51
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.51 / $8.51 / $10.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $6.31 / $6.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $6.31
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $12.02 / $20.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.31 / $12.88 / $20.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $7.59 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.91 / $9.55 / $9.77
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $11.75
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $8.71 / $15.85
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $9.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $8.51 / $10.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.80 / $4.17 / $6.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.89 / $4.37 / $7.94
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.75 / $8.51 / $15.14