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Louisiana rates for HCPCS A4422

Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.23 / $0.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.11 / $0.11
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.08 / $0.11