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Washington 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
$0.09 / $0.20 / $0.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.09 / $0.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.14 / $1.12
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 / $0.12
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.54 / $0.85
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.54 / $0.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $75.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.15
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.14 / $0.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.15 / $0.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.13 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.08 / $0.08