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Washington rates for HCPCS A5055

Stoma cap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $2.59 / $2.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.13 / $2.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.31
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.77 / $9.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.38
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $2.13 / $3.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $2.31 / $3.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.54 / $1.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.81 / $1.95 / $2.00
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $1.95 / $2.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $1.76 / $3.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.90 / $2.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.71 / $2.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.85 / $1.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.30 / $1.30