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Washington rates for HCPCS A5054

Ostomy Pouch Closed; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) M: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $3.22 / $3.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.08 / $1.42 / $3.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.20 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.22 / $12.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.12 / $2.66 / $4.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.89 / $4.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.93 / $2.12
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.45 / $2.50
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.50 / $2.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.20 / $4.05
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.38 / $3.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.13 / $2.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.07 / $2.02
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.37 / $1.37