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New Jersey rates for HCPCS A4389

Ostomy pouch, drainable, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $4.24 / $7.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $6.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.27 / $6.66 / $9.53
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $5.78 / $5.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $4.33 / $6.80