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Massachusetts rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.32
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.14 / $79.43
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.51 / $2.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $4.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.48 / $1.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.26 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $2.82
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
$1.82 / $1.82 / $2.75
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.10 / $1.10
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.14 / $79.43
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.58 / $2.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.68 / $0.87 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.20 / $1.82