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Montana rates for HCPCS A5057

Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.52 / $38.72 / $38.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.10 / $13.10 / $13.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $14.08 / $14.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.31 / $14.08 / $14.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $13.41 / $14.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.49 / $10.58 / $14.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.26 / $5.69 / $6.51