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New Mexico rates for HCPCS A4417

Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.78 / $3.78 / $3.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.13 / $3.69 / $15.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $4.16 / $4.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $3.13 / $3.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.13 / $3.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.16 / $5.21 / $7.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $3.68 / $6.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.21 / $3.32