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Wisconsin rates for HCPCS A4392

Ostomy Pouch Urinary With Standard Wear Barrier Attached With Built-In Convexity (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.63 / $6.63 / $6.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $7.23 / $9.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.42 / $12.56 / $20.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.62 / $10.62 / $14.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.21 / $24.44 / $24.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $30.64 / $47.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $16.67 / $21.61
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $9.57 / $13.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.54 / $11.42 / $13.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.56 / $11.93 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.48 / $5.69 / $12.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.24 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $9.94 / $13.13
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.54 / $11.42 / $13.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $17.57 / $29.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $22.30 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $6.86 / $56.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $11.42 / $11.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.42 / $11.42 / $11.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.69 / $9.80