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New York rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $2.50 / $2.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $2.31 / $2.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $4.42
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.44 / $2.62 / $2.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.62 / $2.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.33
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $7.07 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $2.64 / $5.75
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.26 / $3.26 / $3.26
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $2.10 / $3.26
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $4.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.94 / $3.18
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.96 / $1.98 / $3.06
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.96 / $1.98 / $3.26