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New York rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.84 / $6.56 / $12.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $6.58 / $12.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.72 / $7.72 / $7.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $8.44 / $17.69
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.40 / $11.18 / $11.18
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.18 / $11.18 / $11.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $30.17 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $9.66 / $23.74
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.49 / $8.49 / $8.49
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $9.71 / $10.19
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.02 / $8.02 / $8.02
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.07
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.22 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $11.40
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.61 / $9.71 / $9.71
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.49 / $9.71 / $9.71