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New Hampshire rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.10 / $1.23 / $1.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.25 / $1.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $6.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.25 / $1.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.86 / $2.37