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New Hampshire rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.19 / $5.19 / $6.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.32 / $4.84 / $5.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $4.95 / $4.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.04 / $5.04 / $6.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $8.05 / $24.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.93 / $5.66
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.65 / $7.32 / $9.31