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Michigan rates for HCPCS A2013

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,348.96 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $1,380.38 / $1,380.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $134.90 / $346.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $181.97 / $1,380.38
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $1,380.38 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,348.96 / $1,348.96