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Massachusetts rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $2.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $10.76 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $2.54 / $3.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.39 / $2.68 / $2.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.27 / $4.50
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
$3.09 / $3.09 / $3.24
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.16
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.67 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.88 / $3.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.04 / $3.69