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Wisconsin rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.99 / $2.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $3.45 / $5.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.92 / $2.92 / $3.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $6.72 / $6.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $8.11 / $12.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $4.76 / $5.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $2.71 / $3.61
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.77 / $3.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.28 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $2.38 / $3.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.17 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $2.73 / $3.61
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.77 / $3.77
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $4.84 / $8.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $6.14 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $15.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $2.00 / $3.97