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Montana rates for HCPCS A5072

Ostomy Pouch Urinary; Without Barrier Attached (1piece) Each (Updated 01-01-2003) 30)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $14.23 / $14.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $3.89 / $4.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $3.41 / $4.41
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $4.20 / $4.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $3.37 / $4.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.09 / $2.40