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Montana rates for HCPCS A5054

Ostomy pouch, closed; for use on barrier with flange (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $7.25 / $7.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $2.64 / $2.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $2.64 / $2.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.22 / $2.50 / $2.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $1.98 / $2.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.07 / $1.25