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New Jersey rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.58 / $5.58 / $5.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.35 / $5.58 / $9.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $8.07
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.85 / $12.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $3.87 / $7.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.40 / $5.69 / $9.49