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Michigan rates for HCPCS A4331

Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $13.18 / $25.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $4.47 / $4.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $6.61
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $4.68 / $8.71
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.24 / $5.37
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $5.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $2.69 / $2.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.04 / $3.16