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Massachusetts rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.52 / $5.52 / $5.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.21 / $5.52 / $9.49
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.50 / $35.97 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $8.50 / $12.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.75 / $8.75 / $25.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $8.98 / $8.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.00 / $7.59 / $9.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.59 / $14.63
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
$10.30 / $10.30 / $10.82
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.38 / $6.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.64 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.43 / $6.30 / $12.33
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.80 / $6.30 / $12.33