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Michigan rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $9.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $7.08 / $7.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.47 / $7.08 / $7.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $9.55
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $11.75 / $22.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.94 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $7.59 / $12.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $8.13 / $125.89