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New Hampshire rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.64 / $6.64 / $7.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.19 / $7.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.33 / $6.33 / $6.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $8.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $6.45 / $8.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $10.30 / $31.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $6.30 / $9.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.50 / $9.35 / $11.90