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Montana rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.29 / $14.44 / $14.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $5.25 / $5.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.54 / $5.25 / $5.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.43 / $5.00 / $5.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.94 / $4.03 / $5.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $2.12 / $2.50