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New York 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
$0.07 / $0.08 / $0.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.08 / $0.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.12
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.34 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.13 / $0.27
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.13
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.13
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13