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New Jersey rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.56 / $6.56 / $6.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $6.56 / $11.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.50 / $7.96 / $14.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.93 / $8.93 / $8.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.17 / $6.70 / $11.16