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Michigan rates for HCPCS A5054

Ostomy Pouch Closed; For Use On Barrier With Flange (2 Piece) Each (Updated 01-01-2003) M: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.91 / $1.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $7.64 / $13.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.38 / $2.50 / $3.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1.63 / $1.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.60 / $2.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.44 / $1.60 / $1.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.91 / $2.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.26 / $2.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $1.18 / $1.78