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Washington rates for HCPCS A5072

Ostomy Pouch Urinary; Without Barrier Attached (1piece) Each (Updated 01-01-2003) 30)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $6.33 / $6.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $2.79 / $6.61
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.32 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $4.32 / $24.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $2.86 / $3.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.43 / $3.41
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.81 / $5.17 / $8.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.81 / $5.17 / $9.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $3.78 / $4.15
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.41 / $4.90
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $4.90 / $4.94
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $4.32 / $7.99
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.68 / $7.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.92 / $4.20 / $5.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.25 / $4.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.46