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Texas rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.68 / $4.33 / $5.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.26 / $5.70 / $7.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.20 / $5.20 / $5.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $8.09 / $23.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $4.63
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $6.94 / $10.74
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.67 / $8.67 / $8.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $5.78
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
$43.18 / $43.18 / $65.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $6.38 / $8.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.31 / $7.80 / $8.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $6.22 / $8.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $7.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.98 / $5.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $8.67