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Texas rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.92 / $2.49 / $2.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.52 / $3.37
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.45 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.20 / $4.70 / $10.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.06
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $3.08 / $4.76
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.85 / $3.85 / $3.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.96 / $2.45
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
$19.17 / $19.17 / $28.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $2.83 / $3.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $3.47 / $3.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $2.75 / $3.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.96 / $3.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.78 / $2.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $3.85