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New Hampshire rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $3.16 / $3.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $7.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $4.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $3.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $9.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $2.04 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.25
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.07 / $4.07 / $6.46