go back

Wisconsin rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Facilitymedian $5 · 10th–90th $5$100%20%40%10th90th$5Professionalmedian $4 · 10th–90th $2$80%10%20%10th90th$4$2.0$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
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $3.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $8.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.47 / $4.90 / $5.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $16.98 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $7.59 / $10.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.95 / $4.47 / $7.59
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.68 / $10.72 / $13.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.02 / $5.25 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.19 / $2.57 / $5.75
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.89 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.32 / $8.32 / $8.32
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.80 / $6.03 / $10.47
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.37 / $7.94 / $13.80
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $10.47 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $5.37 / $25.70
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.37
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $5.37
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.70 / $2.34 / $3.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.74 / $2.57 / $4.17