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Montana rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.75 / $1.75 / $1.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $2.24 / $2.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.83 / $2.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $2.41 / $2.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.90 / $2.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $1.03 / $1.21