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Texas rates for HCPCS A5073

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $2.88 / $3.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.92 / $3.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $2.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $5.42 / $12.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.12 / $2.37
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.77 / $3.55 / $5.49
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.44 / $4.44 / $4.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $2.67 / $3.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.27 / $3.30
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
$21.98 / $21.98 / $32.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $3.34 / $4.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $4.00 / $4.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $3.18 / $4.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.27 / $3.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $2.04 / $2.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.13 / $2.13 / $4.44