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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
$3.35 / $3.76 / $7.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $3.76 / $7.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.85 / $5.08 / $10.35
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.96 / $6.41 / $6.41
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.41 / $6.41 / $6.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $5.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $3.93 / $5.71
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.70 / $17.32 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.54 / $5.83 / $13.63
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.83 / $5.83 / $5.83
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.56 / $5.56 / $6.41
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.93 / $4.93 / $4.93
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.93 / $4.72 / $11.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $3.84 / $6.55
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.56 / $5.56
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.56 / $5.56 / $5.83