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Washington rates for HCPCS A5055

Stoma cap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $2.88 / $4.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.95 / $4.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.55 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $1.95 / $2.00
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.95 / $2.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $1.78 / $3.24
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.66 / $2.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.74 / $2.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $0.78 / $0.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.85 / $1.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.74 / $3.09