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New York rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.25 / $2.54 / $4.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.81 / $2.54 / $4.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $7.67
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $4.34 / $4.34
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $4.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.68
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.21 / $11.72 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.07 / $3.91 / $9.52
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.86 / $3.86 / $3.86
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $3.76 / $4.34
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.65 / $3.65 / $3.65
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.19 / $7.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.60 / $4.69
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $3.76 / $3.76
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $3.76 / $3.86