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Massachusetts rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $10.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $14.13 / $22.91
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $23.44 / $114.82
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $18.20 / $24.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $50.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $16.98 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $16.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $16.60
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $31.62
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $11.48
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $23.44 / $114.82
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $18.62 / $26.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $9.33 / $13.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $13.80 / $20.89