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Texas rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.29 / $4.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $3.29 / $4.38
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $3.18 / $5.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.20 / $5.53 / $13.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $2.67 / $2.67
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $4.00 / $6.18
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.00 / $121.41 / $121.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $3.01
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
$24.90 / $24.90 / $37.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.68 / $5.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $4.50 / $5.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $3.58 / $5.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $4.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $2.31 / $3.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.50 / $5.00