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New Hampshire rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $3.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.54 / $2.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $4.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $2.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $7.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.57 / $3.18
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.31 / $2.95