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Wisconsin rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $4.47 / $4.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.87 / $6.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.70 / $8.47 / $14.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.16 / $7.16 / $9.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.54 / $16.48 / $16.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $23.00 / $32.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $11.43 / $14.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $6.45 / $8.86
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $7.70 / $9.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.74 / $8.05 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.84 / $8.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $6.71 / $8.86
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $7.70 / $9.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $11.87 / $20.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $15.04 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $4.62 / $38.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $3.84 / $6.51