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New Hampshire rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.01 / $6.01 / $7.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $5.60 / $6.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $5.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $5.83 / $8.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.31 / $9.31 / $28.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.69 / $6.95
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.68 / $8.44 / $10.75