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Utah rates for HCPCS A4422

Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each

Insurance Carrier
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.11 / $30.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.16
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.15 / $0.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.15 / $0.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.06 / $0.06 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.07 / $0.10