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New Mexico rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.30 / $8.30 / $8.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.85 / $8.10 / $32.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.84 / $9.11 / $10.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $6.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $6.86 / $8.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.13 / $11.42 / $17.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $8.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.83 / $8.07 / $13.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.44 / $4.84 / $7.30