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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
$3.02 / $3.02 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $3.16 / $3.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.88
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.63
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
$29.51 / $44.67 / $44.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $5.13 / $8.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $3.02 / $5.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.07 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $4.90 / $8.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $4.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $2.34 / $2.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.75 / $3.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17