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Michigan rates for HCPCS A4425

Ostomy pouch, drainable; for use on barrier with nonlocking flange, with filter (two-piece system), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.81 / $3.81 / $3.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.76 / $3.81 / $3.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $5.00 / $5.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $15.21 / $27.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.75 / $5.00 / $6.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.89 / $5.00 / $7.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $6.50 / $7.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.52 / $3.54 / $5.68
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.85 / $3.62 / $3.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $3.81 / $5.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.52 / $3.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $2.31 / $3.54