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Texas rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.63 / $1.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.65 / $2.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.43 / $1.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.34
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $2.00 / $3.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $264.00 / $264.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.61
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
$12.50 / $12.50 / $18.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $1.85 / $2.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $2.25 / $2.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $1.79 / $2.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $2.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $1.15 / $1.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $2.50