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Wisconsin rates for HCPCS A5072

Ostomy pouch, urinary; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.40 / $3.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $8.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $4.68 / $5.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $15.85 / $25.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $6.61 / $9.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $4.17 / $7.24
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.31 / $7.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $4.90 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.51 / $5.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.59 / $13.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $10.00 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.88 / $25.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $2.09 / $3.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.45 / $4.07