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Washington rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.15 / $16.23 / $16.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.43 / $7.15 / $17.14
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.06 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $11.15 / $62.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.28 / $12.73 / $22.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.44 / $12.79 / $23.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.72 / $9.69 / $10.65
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.33 / $12.33 / $12.63
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.04 / $12.63 / $12.63
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.48 / $11.06 / $20.44
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.48 / $11.96 / $18.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.03 / $10.74 / $13.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $5.36 / $10.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.33 / $7.51 / $7.51