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Texas rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $6.03 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.03 / $7.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $6.61 / $6.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $6.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $4.79
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $6.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.89
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
$48.98 / $74.13 / $74.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $8.32 / $13.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.03 / $9.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $8.13 / $14.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $6.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $3.80 / $4.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.57 / $6.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00