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Massachusetts rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.19 / $3.64
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.37 / $14.24 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $3.37 / $4.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.55 / $3.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $5.63
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
$4.08 / $4.08 / $4.28
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.00 / $57.00 / $57.00
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $2.85 / $2.85
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.15 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $2.50 / $4.88
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.20 / $3.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $2.50 / $4.88