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Texas rates for HCPCS A4387

Ostomy Pouch Closed With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $2.04 / $2.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.06 / $2.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.91 / $3.16 / $3.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.50 / $1.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $2.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.64 / $15.64 / $23.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $2.76 / $3.14
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.89 / $3.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.50 / $3.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.52 / $3.97
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.65 / $3.14