go back

Massachusetts rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $3.80 / $6.50
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.84 / $24.71 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $5.84 / $8.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $17.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.49 / $6.18 / $6.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.74 / $5.22 / $6.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $10.13
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
$7.08 / $7.08 / $7.43
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.27 / $5.27 / $5.27
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.60 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.05 / $4.33 / $8.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $4.33 / $8.47