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Washington rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.95 / $4.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.95 / $4.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.58 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $2.04 / $2.09
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.09 / $2.14
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.82 / $3.39
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.82 / $2.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.81 / $0.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $0.87 / $1.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.82 / $3.16