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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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.39
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.80 / $79.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.95 / $3.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.75 / $2.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $2.45
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
$3.39 / $3.39 / $5.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.80 / $79.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.95 / $4.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.51 / $2.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $2.19 / $3.39