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Wisconsin rates for HCPCS A5105

Urinary Suspensory; With Or Without Leg Bag With Or Without Tube Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.07 / $33.07 / $33.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.07 / $35.19 / $43.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.97 / $62.67 / $103.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.90 / $52.98 / $70.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.98 / $121.92 / $121.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.00 / $179.02 / $274.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $94.88 / $107.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.59 / $47.71 / $65.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.61 / $56.97 / $68.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.72 / $59.53 / $257.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.99 / $29.10 / $66.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.20 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.59 / $49.61 / $65.52
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.61 / $56.97 / $68.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.97 / $87.67 / $144.53
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.26 / $111.26 / $257.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $86.56 / $367.11
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.97 / $56.97 / $56.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.97 / $56.97 / $56.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.47 / $28.42 / $56.97