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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
$20.59 / $69.23 / $69.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $22.27 / $25.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $25.19 / $25.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.68 / $23.99 / $25.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.96 / $18.91 / $25.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.19 / $10.18 / $13.74