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Michigan rates for HCPCS A4375

Ostomy pouch, drainable, with faceplate attached, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.27 / $18.27 / $18.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.24 / $18.27 / $18.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $72.34 / $131.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.79 / $23.99 / $32.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.59 / $15.59 / $15.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $19.19 / $19.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $15.93 / $16.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.78 / $15.93 / $27.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.34 / $17.34 / $18.27
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.42 / $18.27 / $26.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.04 / $15.06 / $20.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.97 / $11.27 / $16.96