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Washington rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $4.86 / $5.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.63 / $2.14 / $5.13
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $3.34 / $18.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $3.78 / $6.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $3.84 / $6.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $2.90 / $3.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.40 / $3.69 / $3.78
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.78 / $3.78
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $3.31 / $6.12
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.58 / $5.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.21 / $4.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.61 / $3.06
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $3.22 / $3.22