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Virginia 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
$0.10 / $0.10 / $0.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.10 / $0.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.15 / $0.18
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.10 / $0.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.26
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.13 / $0.23
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.13 / $0.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.12