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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
$4.37 / $4.37 / $5.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $4.37 / $10.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.07 / $4.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.69 / $3.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $3.98 / $7.08
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $5.37 / $8.71