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New York rates for HCPCS A5054

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.22 / $2.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.29 / $2.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.44 / $3.31
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $2.09 / $2.09
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.09 / $2.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $5.65 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.81 / $4.44
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.70
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.81 / $2.04
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.28 / $3.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.25 / $2.13
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $1.81 / $1.81
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.81 / $1.81