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Wisconsin rates for HCPCS A4392

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

Facilitymedian $12 · 10th–90th $10–$210%20%40%10th90th$12Professionalmedian $9 · 10th–90th $6–$170%10%20%10th90th$9$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
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $6.03 / $8.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $19.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $10.72 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $35.48 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $16.60 / $21.88
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.46 / $9.77 / $16.60
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $19.95 / $24.55
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.61 / $11.48 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $5.75 / $12.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.46 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.62 / $18.62 / $18.62
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.32 / $13.18 / $22.91
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $17.38 / $30.90
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.92 / $23.44 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $11.75 / $56.23
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $5.25 / $8.32
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.80 / $5.75 / $9.12