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Montana rates for HCPCS A5052

Ostomy pouch, closed; without barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.78 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.25 / $2.18 / $2.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.18 / $2.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $2.08 / $2.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.67 / $2.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.88 / $1.01