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Wisconsin rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Facilitymedian $6 · 10th–90th $5–$110%20%40%10th90th$6Professionalmedian $4 · 10th–90th $3–$90%20%10th90th$4$2.0$5.0$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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $5.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $10.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.62 / $6.92
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.63 / $19.05 / $30.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.09 / $8.91 / $11.48
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.39 / $5.25 / $8.71
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.50 / $12.02 / $14.79
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.47 / $6.03 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $3.02 / $6.61
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.17 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $9.77
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.37 / $6.92 / $12.02
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $9.12 / $15.85
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.63 / $12.02 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.09 / $6.17 / $29.51
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $6.17
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $6.17 / $6.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.95 / $2.75 / $4.37
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $4.79