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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
$30.20 / $30.20 / $30.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $30.90 / $43.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $48.98 / $58.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $165.96 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $70.79 / $100.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $43.65 / $75.86
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $52.48 / $72.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $52.48 / $245.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $26.30 / $57.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $79.43 / $138.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $104.71 / $245.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $34.67 / $257.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $22.39 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $26.30 / $42.66