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New Jersey rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.87 / $6.17 / $10.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $7.26 / $13.89
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.40 / $8.40 / $8.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.87 / $6.30 / $10.44