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Michigan rates for HCPCS A4391

Ostomy pouch, urinary, with extended wear barrier attached (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.52 / $7.52 / $7.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.45 / $7.52 / $7.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.94 / $30.03 / $54.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.38 / $9.86 / $13.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.42 / $6.42 / $6.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.90 / $7.90 / $7.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.93 / $5.93 / $6.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.13 / $6.19 / $8.21
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.13 / $7.52 / $8.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.02 / $7.52 / $10.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.95 / $6.19 / $8.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $4.59 / $6.98