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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
$2.00 / $2.00 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $2.51 / $2.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $5.37 / $12.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.14
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $3.63 / $5.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.69
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $85.11 / $85.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $32.36 / $32.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $3.72 / $6.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.00 / $3.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.31 / $3.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $3.63 / $6.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.74 / $2.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $2.04 / $2.69
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.57