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Washington rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.11 / $3.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.37 / $2.37
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $2.11 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.12 / $2.65 / $4.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.87 / $4.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.86 / $2.04
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.17 / $2.35 / $2.41
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $2.41 / $2.41
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.11 / $3.90
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.27 / $3.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.04 / $2.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.03 / $1.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.37 / $1.37