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Texas 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 / $0.10 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.11 / $0.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.09
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $3.54 / $3.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.12 / $0.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.14 / $0.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.12 / $0.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.10
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.15