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Texas rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.68 / $8.18 / $8.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.19 / $8.30 / $11.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.21 / $11.86 / $34.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.01 / $6.01 / $6.75
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.88 / $10.10 / $15.62
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.63 / $12.63 / $12.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.03
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
$62.90 / $62.90 / $94.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $9.28 / $12.63
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.73 / $11.37 / $12.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $9.03 / $12.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $10.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $5.83 / $7.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.33 / $6.33 / $12.63