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Texas rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $2.45 / $2.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.48 / $3.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $3.52 / $10.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $2.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $3.78 / $3.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.67
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
$18.82 / $18.82 / $28.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $2.84 / $3.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $3.40 / $3.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $2.70 / $3.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $3.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.75 / $2.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.78