go back

Wisconsin rates for HCPCS A4417

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $3.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.37 / $8.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.90 / $5.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $16.98 / $26.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $7.59 / $10.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $4.37 / $7.59
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $10.72 / $13.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $5.25 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.63 / $5.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $7.94 / $13.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $10.47 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $5.75 / $25.70
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $5.37 / $5.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.19 / $3.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.57 / $4.27