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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
$0.91 / $0.91 / $0.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $1.51
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $4.33 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.39 / $2.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $4.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.47 / $1.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.14 / $1.25 / $1.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $2.81
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
$1.69 / $1.69 / $1.77
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.09
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.22 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $1.04 / $2.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.04 / $2.02