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Wisconsin rates for HCPCS A4417

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity With Filter (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.03 / $3.03 / $3.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.93 / $3.30 / $4.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.21 / $5.73 / $9.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $4.84 / $6.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.75 / $11.15 / $11.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $16.00 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $7.62 / $9.86
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $4.36 / $5.99
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $5.21 / $6.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $5.45 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.60 / $5.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $4.55 / $5.99
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $5.21 / $6.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.21 / $8.00 / $13.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $10.18 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $25.95
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.21 / $5.21 / $5.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.21 / $5.21 / $5.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.60 / $4.40