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Montana rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $7.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $5.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $6.31 / $6.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $5.13 / $6.31
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.89 / $11.48
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $5.89 / $11.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $5.50 / $7.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $6.31 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.29 / $2.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.51 / $3.02