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New Mexico rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $9.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $1.89 / $1.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $2.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.51 / $3.14 / $4.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $2.50 / $2.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.89 / $2.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.38 / $3.97