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Texas rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $7.40 / $29.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.60 / $7.50 / $10.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.53 / $10.63 / $31.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.44 / $5.44 / $6.10
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.42 / $11.42 / $11.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $7.64
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
$56.87 / $56.87 / $85.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $8.40 / $11.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.99 / $10.28 / $11.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $8.18 / $11.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $9.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.04 / $5.27 / $6.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $11.42