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Michigan rates for HCPCS A5053

Ostomy pouch, closed; for use on faceplate, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.83 / $1.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $7.27 / $13.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.41 / $3.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.93 / $1.93 / $1.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $1.37 / $2.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $1.76 / $1.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.83 / $2.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.93 / $2.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.12 / $1.71