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Texas rates for HCPCS A4390

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

Facilitymedian $12 · 10th–90th $7$430%10%20%10th90th$12Professionalmedian $8 · 10th–90th $5$110%20%10th90th$8$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$7.94
Typical High
$8.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$5.62
Median
$7.94
Typical High
$10.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$7.76
Median
$7.76
Typical High
$7.76
BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$13.49
Typical High
$37.15
BCBS
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$6.46
Typical High
$7.24
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$8.32
Median
$10.96
Typical High
$15.14
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$218.78
Typical High
$218.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.13
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.13
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$85.11
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$100.00
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$6.61
Median
$11.22
Typical High
$19.05
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$7.94
Typical High
$12.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$9.12
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$10.72
Typical High
$19.05
Providence
Setting
Professional
Modifier
Global
Typical Low
$6.92
Median
$6.92
Typical High
$8.32
United
Setting
Facility
Modifier
Global
Typical Low
$4.27
Median
$5.37
Typical High
$8.13
United
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$6.17
Typical High
$8.13
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$6.76
Median
$13.80
Typical High
$13.80