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Wisconsin rates for HCPCS A4357

Bedside Drainage Bag Day Or Night With Or Without Anti-Reflux Device With Or Without Tube Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.88 / $7.88 / $7.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.30 / $7.88 / $30.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.57 / $14.93 / $24.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.74 / $12.62 / $16.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.76 / $14.93 / $29.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.57 / $14.25 / $16.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $36.04 / $55.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.93 / $20.00 / $25.68
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.71 / $11.18 / $15.61
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $13.57 / $16.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $14.03 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $7.76 / $15.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.71 / $11.74 / $15.61
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $13.57 / $16.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.57 / $20.88 / $34.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.15 / $26.50 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.93 / $8.15 / $67.58
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.57 / $13.57 / $13.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.57 / $13.57 / $13.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $6.77 / $12.97