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Michigan rates for HCPCS A4423

Ostomy pouch, closed; for use on barrier with locking flange, with filter (two piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.98 / $1.98 / $1.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.98 / $1.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.92 / $7.81 / $14.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.46 / $2.59 / $3.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $2.06 / $2.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $1.56 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.61 / $2.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $1.67 / $1.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.98 / $2.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.16 / $1.46 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.22 / $1.86