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Wisconsin rates for HCPCS A5051

Ostomy Pouch Closed; With Barrier Attached (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.82 / $2.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $3.17 / $5.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.68 / $2.68 / $3.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $6.16 / $6.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $8.11 / $12.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $4.29 / $5.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $2.41 / $3.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.88 / $3.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $3.01 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.44 / $3.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $2.50 / $3.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.88 / $3.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $4.46 / $7.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $5.62 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.73 / $14.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $2.88 / $2.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $2.88 / $2.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.44 / $2.40