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Michigan rates for HCPCS Q4102

Oasis Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.24 / $12.24 / $12.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.24 / $12.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,658.09 / $2,551.41 / $5,107.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.06 / $7.86 / $12.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $11.88 / $15.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $17.82
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $14.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $13.45 / $21.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.80