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Michigan rates for HCPCS A4413

Ostomy pouch, drainable, high output, for use on a barrier with flange (two-piece system), with filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.86 / $5.86 / $5.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.25 / $5.86 / $5.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.66 / $23.22 / $42.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.31 / $7.70 / $10.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.16 / $6.16 / $6.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.62 / $4.62 / $5.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.88 / $4.76 / $6.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.19 / $5.56 / $5.86
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.62 / $5.86 / $8.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.10 / $3.88 / $5.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $3.55 / $5.44