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Montana rates for HCPCS A4398

Ostomy Irrigation Supply; Bag Each (Special Coverage Instructions Apply. See Mcm: 2130a)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.57 / $55.73 / $55.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.86 / $18.86 / $18.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.60 / $20.28 / $20.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.95 / $20.28 / $20.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.39 / $19.30 / $20.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.65 / $15.22 / $20.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $8.19 / $9.64