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New Hampshire rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $2.74 / $3.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.54 / $3.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.60 / $2.60 / $2.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $3.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $13.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.60 / $3.72
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.49 / $4.08 / $6.16