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Montana rates for HCPCS A4392

Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $32.93 / $32.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.15 / $11.15 / $11.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $11.99 / $11.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.07 / $11.99 / $11.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.56 / $11.42 / $11.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.07 / $9.00 / $12.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.84 / $5.54