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New York rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.96 / $4.45 / $8.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.96 / $4.63 / $8.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $6.24 / $12.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.06 / $7.59 / $7.59
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.11 / $20.50 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $6.56 / $16.12
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.91 / $6.91 / $6.91
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.58 / $6.58 / $7.59
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.59 / $13.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.54 / $8.19
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.51 / $6.58 / $6.58
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.58 / $6.58 / $6.91