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New Hampshire rates for HCPCS A5057

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.22 / $7.22 / $8.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.86 / $7.22 / $8.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.56 / $6.56 / $6.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $6.86 / $9.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.95 / $10.95 / $33.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.70 / $10.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.02 / $9.93 / $12.64