go back

Illinois 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 / $0.09 / $0.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.09 / $0.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $1.87 / $6.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.28 / $0.38
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.20 / $0.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.19 / $0.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.13