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Wisconsin rates for HCPCS A4375

Ostomy Pouch Drainable With Faceplate Attached Plastic Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.93 / $13.93 / $13.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.93 / $15.19 / $19.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $26.39 / $43.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.59 / $22.31 / $29.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.26 / $51.34 / $51.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $64.88 / $100.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $34.69 / $45.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $20.10 / $27.59
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.74 / $23.99 / $28.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $25.07 / $112.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.56 / $11.97 / $26.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.57 / $20.90 / $27.59
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.74 / $23.99 / $28.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $36.93 / $61.23
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $46.86 / $112.69
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $15.93 / $119.47
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $23.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $11.97 / $20.30