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Michigan rates for HCPCS A4422

Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.12 / $0.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.22 / $0.46 / $0.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.10 / $0.10 / $0.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.09 / $0.10 / $0.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.08 / $0.10 / $0.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.06 / $0.08 / $0.11