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New Jersey rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.46 / $8.91
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.82 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $3.02 / $4.68