go back

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
$5.14 / $17.28 / $17.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $5.85 / $5.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $6.29 / $6.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.71 / $6.29 / $6.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $5.99 / $6.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.23 / $4.72 / $6.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.54 / $2.99