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Massachusetts rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.66 / $3.66 / $3.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $3.66 / $6.34
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.63 / $23.86 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.23 / $5.63 / $8.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.29 / $5.95 / $5.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $6.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.03 / $9.75
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
$6.83 / $6.83 / $7.17
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.09
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.01 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $4.18 / $8.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.19 / $4.18 / $8.18