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New York rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $4.79 / $6.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.16 / $10.23
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.68 / $5.01 / $5.01
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $9.55 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $6.03
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $10.00 / $23.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $6.76 / $11.75
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $4.57 / $4.79
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.57
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.89 / $5.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $2.34 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $4.37 / $4.79
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.57