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Oregon 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
Professional
Modifier
Low / Median / High Price
$0.05 / $0.11 / $0.45
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 / $0.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.71 / $0.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.14 / $0.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.14 / $0.17
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.14 / $0.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.14 / $0.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.17 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.13