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New Hampshire rates for HCPCS A4367

Ostomy Belt Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.18 / $5.18 / $6.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.04 / $5.05 / $6.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.18 / $6.18 / $6.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $7.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.53 / $7.53 / $23.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.92 / $7.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.22 / $7.46 / $11.76