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New York rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $4.82 / $9.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $5.03 / $9.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $6.53 / $13.19
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.65 / $8.23 / $8.23
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.23 / $8.23 / $8.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.98
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.86 / $22.21 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.65 / $7.40 / $17.47
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $6.46 / $6.46
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.14 / $7.75
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $6.05 / $14.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.93 / $8.39
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.07 / $7.14 / $7.14
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $7.14 / $7.14