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Montana rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $22.21 / $22.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.52 / $7.52 / $7.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $8.09 / $8.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.76 / $8.09 / $8.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.74 / $7.70 / $8.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.44 / $6.07 / $8.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $3.26 / $3.84