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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
$6.70 / $8.69 / $9.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.58 / $8.81 / $11.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.52 / $8.52 / $8.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.67 / $12.50 / $36.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.39 / $6.39 / $7.17
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $10.73 / $16.59
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $217.90 / $217.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $8.53
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
$66.78 / $66.78 / $100.58
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $9.86 / $13.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.21 / $12.07 / $13.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $9.61 / $13.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $11.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.75 / $6.19 / $8.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $13.41