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Massachusetts 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
$0.07 / $0.07 / $0.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.12
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.11 / $0.52 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.11 / $0.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.10
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.15