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Michigan rates for HCPCS A4416

Ostomy pouch, closed, with barrier attached, with filter (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.93 / $2.93 / $2.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.93 / $2.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.83 / $11.61 / $21.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.66 / $3.85 / $5.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.50 / $2.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $3.08 / $3.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $2.31 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.38 / $3.20
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.77 / $2.93
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.93 / $4.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.95 / $2.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.79 / $2.75