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New Jersey rates for HCPCS A4417

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $2.54 / $4.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.75 / $4.79 / $6.83
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $3.46 / $3.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $2.60 / $4.33