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Wisconsin rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.19 / $1.19 / $1.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $1.31 / $1.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.25 / $3.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $1.91 / $2.52
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $4.38 / $4.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $6.31 / $9.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $3.28 / $3.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.79 / $2.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.04 / $2.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $2.41 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $1.19 / $2.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.16 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.79 / $2.46
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $2.04 / $2.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $3.62 / $6.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $4.00 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.36 / $9.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.03 / $2.04