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Michigan rates for HCPCS A4390

Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.22 / $10.22 / $10.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $10.22 / $10.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.29 / $40.79 / $73.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.74 / $13.41 / $18.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.72 / $8.72 / $8.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.73 / $10.73 / $10.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.07 / $8.07 / $8.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.16 / $8.42 / $11.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.43 / $9.36 / $10.22
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.17 / $10.22 / $14.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $8.42 / $11.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.46 / $6.19 / $9.49