go back

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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.08 / $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 / $0.09 / $0.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.07 / $0.10