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New Hampshire rates for HCPCS A5105

Urinary suspensory with leg bag, with or without tube, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.45 / $25.45 / $30.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.15 / $25.45 / $34.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.37 / $28.37 / $28.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.11 / $38.11 / $63.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $23.24 / $40.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.47 / $39.47 / $121.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.10 / $24.16 / $38.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.56 / $35.82 / $45.58