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Ostomy Absorbent Material to Thicken Stomal Output

Illinois rates for HCPCS A4422

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

Rates data updated July 2026.

Facilitymedian $0 · 10th–90th $0$40%20%10th90th$0Professionalmedian $0 · 10th–90th $0$00%20%10th90th$0$0.1$0.2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.09
Median
$0.09
Typical High
$0.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.07
Median
$0.10
Typical High
$0.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$10.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.81
Median
$1.66
Typical High
$6.76
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.11
Median
$0.50
Typical High
$0.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.09
Median
$0.09
Typical High
$0.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.08
Median
$0.08
Typical High
$0.33
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$0.15
Median
$0.28
Typical High
$0.38
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$0.20
Median
$0.20
Typical High
$0.20
Molina
Setting
Professional
Modifier
Global
Typical Low
$0.08
Median
$0.08
Typical High
$0.08
United
Setting
Facility
Modifier
Global
Typical Low
$0.06
Median
$0.15
Typical High
$0.15
United
Setting
Professional
Modifier
Global
Typical Low
$0.06
Median
$0.08
Typical High
$0.13