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Texas rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $5.91 / $6.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $5.99 / $7.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.20 / $8.48 / $24.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $4.87
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $7.29 / $11.25
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.11 / $9.11 / $9.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $6.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $5.79
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
$45.37 / $45.37 / $68.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $6.70 / $9.11
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.58 / $8.19 / $9.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $6.51 / $9.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $7.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $4.19 / $5.53
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $9.11