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Massachusetts rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.76 / $2.50
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $6.88 / $90.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $2.79 / $3.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.83 / $3.83 / $11.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $2.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $3.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $3.75
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
$2.56 / $2.56 / $2.69
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.37 / $90.00 / $90.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.18 / $3.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $2.18 / $3.37