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Michigan rates for HCPCS A4412

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $2.88 / $2.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.09 / $2.88 / $2.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.72 / $11.40 / $20.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.78 / $5.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.46 / $2.46 / $2.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.27 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.48 / $3.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.74 / $2.88 / $6.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.88 / $4.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $2.48 / $3.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.78 / $2.97