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Massachusetts rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $6.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.12 / $25.96 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $6.12 / $8.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.74 / $6.48 / $6.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $7.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $10.50
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
$7.42 / $7.42 / $7.79
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $4.32 / $4.32
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.48 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $4.54 / $8.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.27 / $4.54 / $8.90