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New Hampshire rates for HCPCS A4389

Ostomy Pouch Drainable With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $5.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $4.26 / $5.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.34 / $4.34 / $4.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.44 / $6.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $21.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.89 / $4.33 / $5.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $6.42 / $8.18