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New Mexico rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.68 / $10.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $3.02 / $3.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.27 / $2.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.78 / $5.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $1.04 / $2.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $2.67 / $4.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $1.60 / $2.41