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Washington rates for HCPCS A4420

Ostomy pouch, closed; for use on barrier with locking flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $1.54 / $1.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $90.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $1.75 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.71 / $1.72 / $2.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $2.15 / $2.15
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $2.15 / $2.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.75