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Massachusetts rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.89 / $79.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $4.57 / $6.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.07 / $12.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $4.27 / $4.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $3.63 / $4.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $4.47
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
$5.25 / $5.25 / $7.94
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.47 / $3.47
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.89 / $79.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $4.57 / $6.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $2.51 / $3.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $3.47 / $5.25