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Wisconsin rates for HCPCS A4376

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

Facilitymedian $68 · 10th–90th $59$1230%20%40%10th90th$68Professionalmedian $52 · 10th–90th $33$1020%10%20%10th90th$52$20.0$50.0$100.0$200.0

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
$38.02 / $38.02 / $38.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $38.90 / $57.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $112.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $63.10 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $208.93 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $95.50 / $128.82
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $57.54 / $95.50
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $87.10
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $66.07 / $309.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $33.11 / $72.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $34.67 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $75.86 / $131.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $102.33 / $177.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $134.90 / $316.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $67.61 / $331.13
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $30.20 / $48.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $33.11 / $53.70