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Wisconsin rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $10.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $13.80 / $22.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $12.59 / $15.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $41.69 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $19.05 / $25.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $11.22 / $19.50
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $22.91 / $28.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $13.49 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $6.76 / $14.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $20.42 / $35.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $26.92 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $14.79 / $66.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $5.75 / $8.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.76 / $10.96