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New Mexico rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.62 / $6.62 / $6.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.47 / $6.46 / $26.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $7.28 / $8.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $5.47 / $6.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.28 / $9.11 / $13.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $6.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.65 / $6.43 / $10.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $3.86 / $5.81