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Wisconsin rates for HCPCS A4369

Ostomy Skin Barrier Liquid (Spray Brush Etc) Per Oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.97 / $1.97 / $1.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.15 / $2.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.73 / $6.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $3.15 / $4.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.44 / $7.25 / $7.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $9.01 / $14.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $4.76 / $6.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $2.79 / $3.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $2.88 / $4.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $3.39 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.71 / $3.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $2.96 / $3.90
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $2.88 / $4.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $5.22 / $9.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $6.62 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.04 / $17.67
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.69 / $2.87