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New Mexico rates for HCPCS A4422

Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.11 / $0.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.12 / $0.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.09 / $0.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.16 / $0.24
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.11 / $0.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.07 / $0.07 / $0.11