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Washington rates for HCPCS A5073

Ostomy pouch, urinary; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $5.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $3.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.31
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $5.75 / $9.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $6.17 / $9.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.39 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $3.98 / $4.47
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $4.17 / $4.47
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.80 / $7.08
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $4.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.80 / $4.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $1.70 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.91 / $3.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.80 / $6.76