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Washington rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $6.70 / $6.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $2.95 / $7.07
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.77 / $4.59 / $25.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.68
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.10 / $5.30 / $8.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.10 / $5.38 / $9.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.99 / $4.38
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.66 / $5.09 / $5.21
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.66 / $5.21 / $5.21
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.33 / $4.55 / $8.44
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.94 / $7.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.43 / $5.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.21 / $4.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.60