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Montana rates for HCPCS A4369

Ostomy skin barrier, liquid (spray, brush, etc.), per oz

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.00 / $3.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $3.02 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.45 / $3.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.82 / $5.50
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.82 / $5.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $2.69 / $3.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $3.02 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.29 / $1.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.45 / $1.70