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Wisconsin rates for HCPCS A5073

Ostomy pouch, urinary; for use on barrier with flange (two 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
$1.00 / $2.00 / $3.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $7.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.17 / $5.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $13.80 / $21.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $6.61 / $8.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $3.63 / $6.46
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $8.32 / $10.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $4.47 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.24 / $4.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $6.76 / $11.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $8.91 / $79.43
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $4.79 / $21.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.57
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.91 / $2.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.19 / $3.63