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Michigan rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $22.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $24.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.81 / $85.88 / $171.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $27.28 / $36.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.29 / $24.39 / $24.39
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $30.41 / $30.41
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $30.41 / $36.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.60 / $30.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $34.43