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Ohio 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
$0.10 / $0.10 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.10 / $0.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.15 / $0.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.12
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $0.11