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Washington rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.74 / $10.76 / $11.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $4.74 / $11.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.33 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $7.39 / $41.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $5.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $5.92
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $8.48 / $14.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.96 / $8.60 / $14.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.77 / $6.42 / $7.06
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.51 / $8.18 / $8.38
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.32 / $8.38 / $9.22
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.95 / $7.33 / $13.56
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.95 / $7.93 / $12.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.65 / $7.12 / $9.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $3.55 / $6.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.12 / $4.20