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Texas 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
$1.89 / $2.48 / $2.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.48 / $3.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.40 / $2.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.41 / $4.18 / $10.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $2.02
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.33 / $3.02 / $4.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $55.71 / $55.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.40
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
$18.82 / $18.82 / $28.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $2.78 / $3.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $3.48 / $4.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $2.70 / $3.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $3.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.72 / $2.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.78