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Massachusetts rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $1.68 / $2.92
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.59 / $10.97 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.59 / $3.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.43 / $2.74 / $2.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $3.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $2.31 / $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
$3.14 / $3.14 / $3.30
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.94 / $1.94 / $1.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.82 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.92 / $3.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.92 / $3.76