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Massachusetts rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.08 / $10.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $11.22 / $79.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $8.71 / $11.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.31 / $19.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.24 / $8.13 / $8.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $6.92 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $7.59
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
$10.00 / $10.00 / $15.14
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $11.22 / $79.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $8.71 / $12.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $4.79 / $6.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $6.61 / $10.00