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New York rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $4.24 / $8.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $4.24 / $8.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $5.30 / $11.46
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.72 / $7.23 / $7.23
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.23 / $7.23 / $7.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $6.14
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.67 / $19.51 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.12 / $6.50 / $15.35
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.52 / $6.52 / $6.52
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $6.28 / $7.23
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.75 / $6.75 / $6.75
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.32 / $12.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $4.33 / $7.37
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.22 / $6.28 / $6.28
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $6.28 / $6.52