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Washington rates for HCPCS A5056

Ostomy pouch, drainable, with extended wear barrier attached, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.70 / $8.40 / $8.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $3.79 / $8.86
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.25 / $4.25 / $4.25
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.55 / $75.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $5.72 / $32.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.93 / $3.93 / $4.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $3.34 / $4.62
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $6.53 / $11.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $6.69 / $11.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $5.00 / $5.50
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.84 / $6.38 / $6.53
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.70 / $6.53 / $6.53
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.42 / $5.72 / $10.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $6.19 / $9.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.18 / $5.55 / $7.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.77 / $5.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $6.14 / $6.14