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Washington rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.16 / $11.71 / $12.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.92 / $5.16 / $12.37
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.98 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.58 / $8.05 / $45.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.27 / $9.11 / $14.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.27 / $9.22 / $16.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $6.98 / $7.67
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $8.90 / $9.11
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $9.11 / $9.11
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.98 / $14.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $8.63 / $13.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.23 / $7.74 / $10.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.56 / $3.86 / $7.37
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $4.55