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New York rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.19 / $2.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.19 / $2.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.14 / $3.42
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.78 / $1.91 / $1.91
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $1.41
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $5.15 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.75 / $4.19
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.75 / $1.75 / $1.75
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.91
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.15 / $2.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.14 / $1.98
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.88
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.75