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Texas rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.84 / $4.99 / $5.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.77 / $5.05 / $6.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.62 / $4.62 / $4.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $4.38 / $4.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.67 / $3.67 / $4.11
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $6.16 / $9.51
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.53 / $4.62 / $5.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $5.44
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
$38.35 / $38.35 / $57.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $5.66 / $7.70
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.71 / $6.93 / $7.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $5.50 / $7.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $6.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $3.55 / $4.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.85 / $3.85 / $7.70