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Nebraska 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
$0.13 / $0.13 / $0.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.17 / $0.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.17 / $0.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.17 / $0.17 / $0.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.20 / $0.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.11