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Michigan rates for HCPCS A2011

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $93.33 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $154.88 / $186.21
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $131.83 / $346.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $117.49 / $165.96
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89