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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
$2.61 / $2.93 / $5.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $3.09 / $5.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $8.86
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.63 / $4.99 / $4.99
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.99 / $4.99 / $4.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.44
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $13.48 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $4.55 / $10.96
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $4.55
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $4.99
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.60 / $8.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.99 / $5.17
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.29 / $4.33 / $4.33
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $4.33 / $4.55