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Wisconsin rates for HCPCS A5073

Ostomy Pouch Urinary; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) Cm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.58 / $2.58 / $2.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $2.81 / $3.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.44 / $4.88 / $8.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $5.46
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.19 / $9.50 / $9.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $11.71 / $18.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $6.67 / $8.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $3.67 / $5.11
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $4.44 / $5.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $4.63 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $2.21 / $4.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $3.87 / $5.11
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $4.44 / $5.33
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $6.84 / $11.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $8.68 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.67 / $21.98
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $4.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $4.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.21 / $4.44