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New Mexico rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.64 / $3.64 / $3.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.55 / $14.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.99 / $3.99 / $4.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.56 / $5.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $7.32 / $10.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $3.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $3.54 / $5.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.12 / $3.20