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Ostomy Pouch, Drainable, Barrier with Flange

Wisconsin rates for HCPCS A5063

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

Rates data updated July 2026.

Facilitymedian $4 · 10th–90th $3$70%20%40%10th90th$4Professionalmedian $4 · 10th–90th $2$60%20%10th90th$4$1.0$2.0$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$2.19
Typical High
$2.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.19
Typical High
$3.16
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$6.31
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.63
Median
$3.63
Typical High
$4.37
CareSource
Setting
Facility
Modifier
Global
Typical Low
$4.57
Median
$4.57
Typical High
$4.57
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$12.30
Typical High
$19.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$5.75
Typical High
$7.24
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$2.14
Median
$3.39
Typical High
$5.62
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$3.47
Median
$6.31
Typical High
$7.59
Medica
Setting
Facility
Modifier
Global
Typical Low
$2.19
Median
$3.80
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$1.91
Typical High
$4.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03
Network Health
Setting
Professional
Modifier
Global
Typical Low
$2.75
Median
$4.37
Typical High
$7.59
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$2.14
Median
$3.39
Typical High
$5.62
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$2.14
Median
$2.14
Typical High
$3.80
Quartz
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$5.75
Typical High
$10.00
Quartz
Setting
Facility
Modifier
Global
Typical Low
$2.29
Median
$7.76
Typical High
$79.43
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$5.75
Typical High
$19.05
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3.89
Median
$3.89
Typical High
$3.89
United
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.74
Typical High
$3.89
United
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.86
Typical High
$3.24