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New Hampshire rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.02 / $1.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.69 / $5.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.04 / $1.27
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.53 / $1.95