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New Jersey rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.85 / $3.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.48 / $4.92 / $5.23
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $2.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.88 / $3.09