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New Mexico rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $9.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $6.17 / $10.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $4.47 / $6.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.09 / $7.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.29 / $2.34 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.51 / $3.80