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Wisconsin rates for HCPCS A5071

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.87 / $4.87 / $4.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.87 / $5.31 / $6.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.40 / $9.24 / $15.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.26 / $7.81 / $10.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.04 / $17.98 / $17.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.04 / $22.53 / $34.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $12.38 / $15.89
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $7.03 / $9.66
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $8.40 / $10.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.09 / $8.77 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.29 / $4.19 / $9.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $7.31 / $9.66
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $8.40 / $10.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.40 / $12.90 / $21.08
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.04 / $16.39 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.04 / $41.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.40 / $8.40 / $8.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.40 / $8.40 / $8.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.19 / $7.20