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Wisconsin rates for HCPCS A4393

Ostomy pouch, urinary, 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 / $7.08 / $10.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $21.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $12.02 / $14.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $39.81 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $18.20 / $24.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $10.47 / $18.20
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $22.39 / $26.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $12.59 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $6.31 / $13.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $19.50 / $33.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $25.70 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $13.80 / $63.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $5.37 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $6.31 / $10.47