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Wisconsin rates for HCPCS A4377

Ostomy Pouch Drainable For Use On Faceplate Plastic Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.48 / $3.48 / $3.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.48 / $3.79 / $4.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $6.59 / $10.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.57 / $5.57 / $7.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $12.82 / $12.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $16.22 / $25.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $9.05 / $11.34
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $5.01 / $6.89
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $5.99 / $7.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $6.26 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.99 / $6.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $5.22 / $6.89
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $5.99 / $7.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.99 / $9.23 / $15.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $11.70 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $29.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.99 / $5.99 / $5.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.99 / $5.99 / $5.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.99 / $4.98