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Texas rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $7.94 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $10.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.76 / $7.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $13.49 / $37.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $6.46
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $10.96 / $15.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $218.78 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $8.13
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
$66.07 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $11.48 / $18.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.94 / $12.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $9.12 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $10.96 / $19.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $9.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $5.25 / $6.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $6.17 / $8.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $13.80 / $13.80