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Wisconsin rates for HCPCS A4360

Disposable external urethral clamp or compression device, with pad and/or pouch, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.15 / $1.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $2.00 / $2.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $1.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $2.09 / $3.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.93 / $1.32
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.50 / $0.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.69 / $0.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.55 / $1.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.34 / $3.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $1.07 / $2.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $1.05 / $3.98
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.34 / $0.54