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Montana rates for HCPCS A4393

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.84 / $36.44 / $36.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.33 / $12.33 / $12.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $13.26 / $13.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.82 / $13.26 / $13.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.14 / $12.63 / $13.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.93 / $9.94 / $13.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.84 / $5.36 / $6.13