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New York rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $6.17 / $8.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.98 / $7.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $5.50 / $12.02
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.46 / $6.46
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.46 / $6.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $12.30 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $7.76
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $12.88 / $30.20
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $7.76 / $14.79
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $5.89 / $6.17
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.62 / $5.89
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $7.59 / $7.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $3.02 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.57 / $3.80 / $6.46
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.62 / $6.17
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $5.62 / $5.89