go back

Montana rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Facilitymedian $23 · 10th–90th $15$300%20%10th90th$23Professionalmedian $19 · 10th–90th $10$320%10%10th90th$19$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$16.98
Typical High
$32.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$25.12
Typical High
$25.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$25.12
Typical High
$25.12
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$18.62
Median
$23.44
Typical High
$45.71
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$23.44
Typical High
$45.71
Providence
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$22.39
Typical High
$28.84
Providence
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$25.12
Typical High
$79.43
United
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$9.33
Typical High
$9.33
United
Setting
Professional
Modifier
Global
Typical Low
$9.12
Median
$10.23
Typical High
$13.80