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New Mexico rates for HCPCS A4389

Ostomy Pouch Drainable With Barrier Attached With Built-In Convexity (1 Piece) Each (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.20 / $6.16 / $25.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.57 / $42.26 / $75.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.20 / $6.93 / $8.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.22 / $5.22 / $5.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $5.22 / $6.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.93 / $8.67 / $13.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.38 / $2.38 / $6.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $6.14 / $10.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.38 / $3.68 / $5.55