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Michigan rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.33 / $54.33 / $54.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $54.33 / $54.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.58 / $60.90 / $121.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.38 / $45.71 / $61.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $67.01
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $52.75 / $79.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $65.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.85 / $58.02 / $87.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $55.97