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New Hampshire rates for HCPCS A5073

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $5.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $3.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $3.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $3.89 / $6.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.51 / $1.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.19 / $3.89
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $4.79