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Texas rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $18 · 10th–90th $12$650%10%20%10th90th$18Professionalmedian $14 · 10th–90th $10$200%20%10th90th$14$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$12.02
Median
$15.14
Typical High
$16.98
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10.23
Median
$15.14
Typical High
$19.95
BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$15.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Christus
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$24.55
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$15.85
Typical High
$16.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$13.49
Typical High
$13.49
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$181.97
Typical High
$181.97
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$19.95
Typical High
$35.48
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$10.96
Median
$15.14
Typical High
$23.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$16.22
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$12.02
Median
$19.50
Typical High
$33.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$13.49
Typical High
$13.49
United
Setting
Facility
Modifier
Global
Typical Low
$7.59
Median
$9.77
Typical High
$14.45
United
Setting
Professional
Modifier
Global
Typical Low
$8.51
Median
$10.96
Typical High
$14.45
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$24.55
Typical High
$24.55