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Montana rates for HCPCS A4387

Ostomy pouch, closed, with barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.70 / $9.06 / $9.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $3.30 / $3.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $3.30 / $3.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.89 / $3.14 / $3.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.22 / $2.48 / $3.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.33 / $2.58