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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
$3.15 / $3.15 / $3.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $2.93 / $3.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.06 / $3.06 / $4.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $15.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.99 / $3.65
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.04 / $4.44 / $5.66