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Michigan rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.59 / $42.59 / $42.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $45.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.95 / $189.91 / $378.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.50 / $52.00 / $67.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.02 / $45.25 / $45.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.38 / $35.97 / $42.59
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $42.59 / $51.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $47.81