go back

New Hampshire rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.06 / $7.06 / $8.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.86 / $6.58 / $8.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $6.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $10.95 / $33.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $7.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.02 / $9.93 / $12.64