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New York rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $9.12 / $13.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $7.08 / $10.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $8.71 / $16.60
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $9.55 / $9.55
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.55 / $9.55 / $9.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $18.20 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $11.48
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $19.05 / $44.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $11.75 / $21.88
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.71 / $8.71 / $9.12
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.32 / $8.71
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $11.22 / $11.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $4.47 / $7.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.75 / $9.55
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $8.32 / $9.12
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $8.32 / $8.71