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Montana rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $8.91 / $18.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.13 / $14.13 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $11.48 / $14.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.23 / $13.18 / $25.70
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.23 / $13.18 / $25.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $12.59 / $16.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $14.13 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $5.13 / $5.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $5.75 / $6.76