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Texas rates for HCPCS A4417

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.60 / $3.37 / $3.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $3.42 / $4.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $2.97 / $3.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.48 / $2.78
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.25 / $4.17 / $6.44
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.21 / $5.21 / $5.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.60
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
$25.95 / $25.95 / $39.08
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $3.83 / $5.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.19 / $4.69 / $5.21
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $3.72 / $5.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $4.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $2.40 / $3.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $5.21