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Michigan rates for HCPCS A4392

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.69 / $8.69 / $8.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.30 / $8.69 / $8.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.29 / $34.44 / $62.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.85 / $11.42 / $15.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.42 / $7.42 / $7.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.14 / $9.14 / $9.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.86 / $6.86 / $7.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $6.86 / $9.49
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.26 / $8.32 / $9.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.86 / $8.69 / $11.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.66 / $5.83 / $8.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.79 / $5.32 / $7.88