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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
$12.61 / $12.61 / $15.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.49 / $11.77 / $14.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.03 / $12.03 / $12.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $13.54 / $15.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.55 / $19.55 / $60.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $11.97 / $14.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.14 / $17.75 / $22.60