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Texas rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $15.14 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $15.14 / $20.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $12.59 / $15.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $24.55 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $13.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $114.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $181.97 / $181.97
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $20.42 / $33.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $15.14 / $23.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $19.50 / $35.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $13.49 / $15.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $9.33 / $11.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $10.96 / $14.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $24.55 / $24.55