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Texas rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Facilitymedian $4 · 10th–90th $2$110%10%20%10th90th$4Professionalmedian $3 · 10th–90th $2$40%20%40%10th90th$3$0.1$0.5$5.0$50.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.57 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $3.98
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.16 / $3.16 / $3.16
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.75 / $2.75 / $3.31
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $2.75
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.16 / $4.27 / $6.46
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $5.37 / $79.43
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.16 / $3.16 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $2.63 / $3.16
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $85.11
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.30 / $38.90 / $38.90
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $4.27 / $7.59
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $3.02 / $5.01
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.95 / $2.95 / $81.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.57 / $4.17 / $7.41
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.63 / $2.63 / $3.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.66 / $2.09 / $3.16
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $2.40 / $3.16
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.57 / $5.37 / $5.37