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Montana rates for HCPCS A4417

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $15.03 / $15.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.13 / $5.47 / $5.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $5.47 / $5.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $5.21 / $5.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $4.09 / $5.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.21 / $3.68