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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
$3.98 / $3.98 / $3.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.02 / $5.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $18.20 / $34.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3.89 / $3.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.63 / $7.24
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $11.48 / $12.59
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $4.79 / $7.41
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.09 / $3.63 / $4.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $2.29 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.82 / $4.27