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New Hampshire rates for HCPCS A5056

Ostomy pouch, drainable, with extended wear barrier attached, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.51 / $3.51 / $4.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.85 / $3.20 / $3.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.20 / $3.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.93 / $3.93 / $4.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $3.34 / $4.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.33 / $5.33 / $16.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.17 / $3.26 / $5.49
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.83 / $6.15