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Wisconsin rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Facilitymedian $10 · 10th–90th $9$180%50%10th90th$10Professionalmedian $7 · 10th–90th $5$150%10%10th90th$7$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $5.01 / $7.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.00 / $10.00 / $16.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $9.33 / $11.22
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $30.20 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $14.45 / $19.05
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.50 / $8.51 / $14.45
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.91 / $14.79 / $18.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.62 / $9.77 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.17 / $4.90 / $10.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $15.85
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $11.22 / $19.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $15.14 / $26.30
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.89 / $19.95 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $10.00 / $48.98
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $10.00 / $10.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $10.00 / $10.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.24 / $4.47 / $7.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.31 / $4.90 / $7.94