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New York rates for HCPCS A4423

Ostomy pouch, closed; for use on barrier with locking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.09 / $2.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.58 / $3.80
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.14 / $2.14
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $4.17 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $2.63
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.63 / $4.37 / $10.23
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.63 / $5.01
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $2.04
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.91
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.66 / $1.66
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.51 / $2.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $1.00 / $1.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.29 / $2.19
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $1.86 / $2.04
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.91