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Wisconsin rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $25 · 10th–90th $21$450%20%40%10th90th$25Professionalmedian $19 · 10th–90th $11$360%10%20%10th90th$19$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $14.13 / $19.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $40.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $22.91 / $27.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $75.86 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $28.84 / $46.77
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $20.89 / $34.67
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $24.55 / $30.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $23.99 / $112.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $12.02 / $26.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $38.90
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $27.54 / $47.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $36.31 / $64.57
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $48.98 / $114.82
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.77 / $15.85 / $120.23
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.76 / $10.96 / $17.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $12.02 / $19.50