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Michigan rates for HCPCS A2005

Microlyte Matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $81,283.05 / $81,283.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $194.98 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $218.78 / $223.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $194.98 / $346.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $158.49 / $234.42
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $218.78 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $257.04