go back

New Mexico rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.43 / $5.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.60 / $1.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.03 / $2.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.35 / $2.94 / $4.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $0.55 / $1.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.38 / $2.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.85 / $1.28