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New York rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.44 / $11.73 / $22.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.44 / $12.36 / $22.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.03 / $12.03 / $35.47
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.59 / $19.98 / $19.98
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.98 / $19.98 / $19.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $15.93
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $53.98 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.15 / $18.22 / $43.90
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.22 / $18.22 / $18.22
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.35 / $17.35 / $19.98
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $28.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $11.97 / $21.59
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.18 / $17.35 / $17.35
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.35 / $17.35 / $18.22