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Montana rates for HCPCS A4563

Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.98 / $1,379.98 / $1,379.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $1,752.44 / $1,752.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $1,752.44 / $1,752.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $1,668.99 / $1,752.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.60 / $1,315.29 / $1,753.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.50 / $69.12 / $172.80