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New Hampshire rates for HCPCS A5072

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.57 / $2.57 / $3.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.57 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $2.88 / $3.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.45 / $2.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $4.37 / $7.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.66 / $2.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.45 / $4.37
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $3.31 / $5.37