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New Hampshire rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $12.59 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.88 / $32.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $19.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $13.49 / $15.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $36.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $8.13 / $9.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $12.02 / $20.89
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $25.70