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Pennsylvania 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
$0.08 / $0.08 / $0.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.10 / $0.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.15
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.28
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.10 / $0.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.30 / $0.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.18
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.15