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Washington rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.18 / $4.95 / $5.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.18 / $5.22
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.37 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.78 / $3.40 / $19.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.96 / $2.72
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $3.85 / $6.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.92 / $6.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.65 / $2.95 / $3.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.45 / $3.76 / $3.85
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.45 / $3.85 / $3.85
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $3.37 / $6.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.65 / $5.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.27 / $4.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.63 / $3.11
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.93