go back

New Hampshire rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $13 · 10th–90th $13–$150%20%40%90th$13Professionalmedian $17 · 10th–90th $11–$320%20%10th90th$17$5.0$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $12.88 / $32.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $19.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $13.49 / $15.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $20.89 / $38.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.31 / $8.13 / $9.77
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $13.80 / $20.89
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.38 / $17.38 / $31.62