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Wisconsin rates for HCPCS A4425

Ostomy Pouch Drainable; For Use On Barrier With Non-Locking Flange With Filter (2 Piece System) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $3.17 / $4.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $5.50 / $9.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.50 / $4.65 / $6.15
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.59 / $6.00 / $10.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.25 / $7.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $15.00 / $20.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $8.33 / $9.46
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $4.19 / $5.75
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $5.00 / $6.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.43 / $5.22 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.52 / $5.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.28 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $4.34 / $5.75
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $5.00 / $6.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $7.70 / $13.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $9.76 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $5.12 / $24.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $5.00 / $5.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.50 / $4.23