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Wisconsin rates for HCPCS A5081

Stoma Plug Or Seal Any Type Revised 1/1/2014

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.69 / $3.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.63 / $5.09 / $8.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.16 / $4.30 / $5.69
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.33 / $9.91 / $9.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $12.62 / $19.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $6.56 / $8.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $3.88 / $5.32
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $4.63 / $5.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $4.84 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $2.31 / $5.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $4.04 / $5.32
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.64 / $4.63 / $5.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $7.13 / $12.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $9.03 / $80.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.60 / $20.34
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $4.63 / $4.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $2.31 / $3.97