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Texas rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.48 / $1.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.50 / $2.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $1.31 / $1.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.22 / $1.22
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.37
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.70 / $17.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.72 / $2.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $2.04 / $2.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.64 / $2.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.12 / $1.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.14 / $2.27