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Texas rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.99 / $3.88 / $4.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $3.93 / $5.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.15 / $3.42 / $3.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $2.85 / $3.20
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $5.99 / $5.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $4.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.17
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
$29.83 / $29.83 / $44.93
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $4.40 / $5.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.67 / $5.39 / $5.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $4.29 / $5.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.77 / $3.65
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $5.99