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New York rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.85 / $3.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.92 / $3.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.49 / $7.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $3.15 / $3.15
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.15 / $3.15 / $3.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.80
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $8.51 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $3.78 / $6.80
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.87 / $2.87 / $2.87
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $3.15
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.31 / $5.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.88 / $3.17
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $2.73 / $2.73
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $2.73 / $2.87