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New Hampshire rates for HCPCS A4435

Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.38 / $4.38 / $5.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $3.95 / $4.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.99 / $4.16 / $4.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.84 / $4.84 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.12 / $5.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.57 / $6.57 / $20.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.68 / $4.01 / $5.32
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.42 / $5.96 / $7.59