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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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $10.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.62 / $6.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $19.05 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $8.91 / $11.48
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $5.01 / $8.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $12.02 / $14.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $6.03 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $3.02 / $6.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $9.12 / $15.85
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $12.02 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $6.61 / $29.51
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.51 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $4.90