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Massachusetts rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $1.10 / $1.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.10 / $1.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $5.09 / $80.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.69 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $1.52 / $4.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.78 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.51 / $3.00
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
$2.04 / $2.04 / $2.15
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.29
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $80.00 / $80.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.25 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.25 / $2.45