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California rates for HCPCS A5063

Ostomy pouch, drainable; for use on barrier with flange (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.11 / $10.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.65 / $10.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $2.84 / $3.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $1.64 / $4.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.52
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.99 / $5.18 / $8.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $8.11 / $14.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $3.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.40
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.78 / $4.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.65 / $5.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.82 / $18.82 / $28.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $3.35 / $3.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.27 / $3.45
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $4.43 / $5.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.60 / $3.68