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Wisconsin rates for HCPCS A4380

Ostomy Pouch Urinary With Faceplate Attached Rubber Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.29 / $30.29 / $30.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.29 / $33.03 / $42.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.16 / $57.38 / $94.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.87 / $48.51 / $64.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.52 / $111.62 / $111.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $140.57 / $218.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.28 / $75.47 / $98.73
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.28 / $43.69 / $59.98
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.86 / $52.16 / $62.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.38 / $54.52 / $245.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.78 / $26.02 / $56.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.11 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.28 / $45.44 / $59.98
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.86 / $52.16 / $62.59
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.16 / $80.27 / $132.49
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $101.88 / $245.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.28 / $34.45 / $229.23
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.16 / $52.16 / $52.16
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.16 / $52.16 / $52.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.35 / $26.02 / $44.73