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New Mexico rates for HCPCS A4390

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.75 / $9.75 / $9.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.05 / $9.52 / $38.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.03 / $10.72 / $12.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.07 / $9.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.72 / $13.41 / $20.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $3.68 / $10.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $9.49 / $15.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.22 / $5.69 / $8.58