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Montana rates for HCPCS A4361

Ostomy Faceplate Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.02 / $74.05 / $74.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.42 / $26.93 / $26.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.88 / $26.93 / $26.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $25.65 / $26.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $20.22 / $26.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.84 / $10.88 / $12.46