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Washington rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.36 / $9.90 / $10.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $4.36 / $10.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.74 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $6.79 / $38.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $5.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $5.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $7.95 / $13.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $7.99 / $14.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.31 / $5.90 / $6.49
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.89 / $7.52 / $7.70
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.89 / $7.70 / $7.70
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.39 / $6.74 / $12.47
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.39 / $7.29 / $11.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.11 / $6.55 / $8.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.01 / $3.26 / $6.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $3.78 / $3.85