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New Mexico rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.18 / $9.18 / $9.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.58 / $8.96 / $36.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.57 / $10.09 / $12.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $7.59 / $8.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.10 / $12.63 / $18.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $3.46 / $9.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.45 / $8.93 / $14.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.91 / $5.36 / $8.07