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Michigan rates for HCPCS A4377

Ostomy pouch, drainable, for use on faceplate, plastic, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.55 / $4.55 / $4.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $4.55 / $4.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.07 / $18.22 / $32.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.69 / $5.99 / $8.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3.89 / $3.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $3.60 / $3.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.20 / $3.71 / $4.98
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.33 / $4.33 / $4.55
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $4.55 / $6.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.00 / $3.76 / $5.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.82 / $4.23