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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
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $7.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $4.68 / $5.50
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $8.32 / $12.30
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.09 / $4.27 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $4.57 / $7.08