HCPCS A4264
Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
Current code27 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | — | — |
| Cascade Valley Hospital | $5,645 | $4,440 | $5,550 |
| Deaconess Medical Center | — | — | — |
| Kadlec Regional Medical Center | — | $149 | $213 |
| Legacy Salmon Creek Medical Center | — | $1,609 | $2,475 |
| Mary Bridge Children's Hospital | — | — | — |
| MultiCare Auburn Medical Center | — | — | — |
| MultiCare Covington Medical Center | — | — | — |
| MultiCare Good Samaritan Hospital | — | — | — |
| MultiCare Valley Hospital | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $209 | $298 |
| Providence Centralia Hospital | — | $221 | $426 |
| Providence Holy Family Hospital | — | $209 | $298 |
| Providence Mount Carmel Hospital | — | $198 | $283 |
| Providence Regional Medical Center Everett | — | $245 – $5,085 | $471 – $9,779 |
| Providence St Joseph Hospital | — | $198 | $283 |
| Providence St Mary Medical Center | — | $172 | $246 |
| Providence St Peter Hospital | — | $221 | $426 |
| Skagit Valley Hospital | — | $4,440 | $5,550 |
| Swedish Edmonds Hospital | — | $152 – $3,085 | $316 – $6,426 |
| Swedish Issaquah | — | $152 – $3,085 | $316 – $6,426 |
| Swedish Medical Center | — | $152 – $3,085 | $316 – $6,426 |
| Swedish Medical Center / Cherry Hill | — | $152 – $3,085 | $316 – $6,426 |
| Tacoma General Allenmore Hospital | — | — | — |
| Virginia Mason Medical Center | — | $3,162 | $6,200 |
| WhidbeyHealth Medical Center | — | $10,407 | $10,407 |
Medicare (traditional) reference
CMS publishes no national amount for this code.