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Montana rates for HCPCS A4376

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.05 / $191.82 / $191.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.94 / $69.80 / $69.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.14 / $69.80 / $69.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.35 / $66.48 / $69.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.99 / $52.39 / $69.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.48 / $28.19 / $33.17