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Michigan rates for HCPCS 41872

Gingivoplasty, each quadrant (specify)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $4,786.30 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $467.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $691.83 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $457.09 / $977.24
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,096.48 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $436.52 / $645.65
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $426.58 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $6,025.60 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $416.87 / $660.69