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Wisconsin rates for HCPCS A4421

Ostomy Supply; Miscellaneous (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.33 / $14.33 / $14.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.55 / $22.55 / $22.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.17 / $19.17 / $23.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $9.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $220.19 / $1,574.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.00 / $9.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.55 / $22.55 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.17 / $22.55 / $22.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.50 / $23.64 / $24.12