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Michigan rates for HCPCS A4354

Insertion Tray With Drainage Bag But Without Catheter (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.83 / $10.83 / $10.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $10.83 / $13.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.63 / $42.88 / $81.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.51 / $14.79 / $18.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.86 / $8.42 / $23.91
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.29 / $10.29 / $11.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.29 / $10.29 / $17.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.86 / $9.03 / $14.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.48 / $6.81 / $10.37