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New Mexico rates for HCPCS A4389

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $6.03 / $7.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $46.77 / $77.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.92 / $8.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $12.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $8.91 / $15.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $6.46 / $9.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $10.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.39 / $8.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.72 / $5.50