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Massachusetts rates for HCPCS A4390

Ostomy Pouch Drainable With Extended Wear Barrier Attached With Built-In Convexity (1 Piece) Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.86 / $5.86 / $5.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.86 / $5.86 / $10.16
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.02 / $38.21 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.24 / $9.02 / $13.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.17 / $9.17 / $27.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.48 / $9.55 / $9.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.53 / $9.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $15.38
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
$10.95 / $10.95 / $11.50
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.63 / $7.63 / $7.63
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.22 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.71 / $6.70 / $13.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.82 / $6.70 / $13.10