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Michigan rates for HCPCS A5055

Stoma Cap (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.53 / $1.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.04 / $6.06 / $11.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.00 / $2.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.61 / $1.61 / $1.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $1.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.26 / $2.27
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.53 / $1.97
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.53 / $2.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $0.97 / $1.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.95 / $1.44