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Massachusetts rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $2.27 / $3.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.49 / $14.85 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.49 / $5.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.29 / $3.71 / $3.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $4.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $6.00
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
$4.24 / $4.24 / $4.45
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.58 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $2.60 / $5.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.60 / $5.09