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Montana rates for HCPCS A4375

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $16.98 / $32.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $22.39 / $25.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $16.98 / $25.12
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $23.44 / $45.71
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $23.44 / $45.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $22.39 / $28.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $25.12 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $9.33 / $9.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $10.23 / $12.02