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Michigan rates for HCPCS A4428

Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (one piece), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.94 / $6.94 / $6.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.03 / $6.94 / $6.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.23 / $5.23 / $5.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.79 / $27.47 / $50.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.65 / $9.11 / $12.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.29 / $7.29 / $7.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.47 / $5.47 / $5.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.51 / $5.63 / $7.57
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.49 / $6.57 / $7.21
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.46 / $6.94 / $9.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.61 / $4.51 / $6.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.03 / $4.26 / $6.43