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Wisconsin rates for HCPCS A4390

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

Facilitymedian $14 · 10th–90th $12$250%20%40%10th90th$14Professionalmedian $10 · 10th–90th $7$200%10%20%10th90th$10$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
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$7.94
Typical High
$10.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$22.39
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.59
Typical High
$15.14
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$41.69
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$19.05
Typical High
$25.70
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$11.48
Typical High
$19.50
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$22.91
Typical High
$28.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$7.76
Median
$13.49
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$5.75
Median
$6.76
Typical High
$14.79
Molina
Setting
Professional
Modifier
Global
Typical Low
$8.91
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$21.88
Typical High
$21.88
Network Health
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$15.49
Typical High
$26.92
Quartz
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$20.42
Typical High
$35.48
Quartz
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$26.92
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$13.80
Typical High
$66.07
Security Health
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
Security Health
Setting
Professional
Modifier
Global
Typical Low
$13.80
Median
$13.80
Typical High
$13.80
United
Setting
Facility
Modifier
Global
Typical Low
$4.37
Median
$6.17
Typical High
$9.77
United
Setting
Professional
Modifier
Global
Typical Low
$4.47
Median
$6.76
Typical High
$10.96