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New Hampshire rates for HCPCS A4390

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

Facilitymedian $7 · 10th–90th $7–$90%20%40%90th$7Professionalmedian $10 · 10th–90th $6–$180%20%10th90th$10$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $8.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $7.08 / $18.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $6.76 / $7.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $10.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.92 / $6.92 / $8.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $21.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.55 / $4.47 / $5.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.68 / $7.76 / $11.75
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.38 / $17.38 / $17.78