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New Hampshire rates for HCPCS A5063

Ostomy pouch, drainable; for use on barrier with flange (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $1.99 / $2.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.85 / $2.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $2.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $9.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.88 / $2.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.79 / $3.56