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New Jersey rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.45 / $4.45 / $4.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $4.45 / $7.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.77 / $6.13 / $10.02
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $6.06 / $6.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $4.54 / $7.57