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Massachusetts rates for HCPCS A4376

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $40.74 / $63.10
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $64.57 / $316.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $50.12 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $138.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $46.77 / $46.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $39.81 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $33.88 / $48.98
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
$57.54 / $57.54 / $89.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $64.57 / $316.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $51.29 / $74.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $25.70 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $38.02 / $57.54