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Montana rates for HCPCS A5063

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $10.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.69 / $3.69 / $3.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $3.97 / $3.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $3.97 / $3.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.84 / $3.78 / $3.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.67 / $2.98 / $3.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.60 / $1.88