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Massachusetts rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $7.94 / $12.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $13.18 / $79.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $10.23 / $13.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $27.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $9.55 / $9.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.51 / $9.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $9.12
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
$11.75 / $11.75 / $17.78
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $13.18 / $79.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $10.47 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $5.25 / $7.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $7.76 / $11.75