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New Hampshire rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $4.78 / $5.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.47 / $5.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $4.55 / $4.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $4.65 / $6.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.42 / $7.42 / $22.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.54 / $6.51
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.12 / $6.73 / $8.57