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New Hampshire rates for HCPCS A4415

Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 in, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.40 / $4.40 / $5.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $4.09 / $5.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $4.20 / $4.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $5.03 / $5.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $4.28 / $5.92
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.83 / $6.83 / $21.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.78 / $4.18 / $6.83
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.63 / $6.19 / $7.88