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Michigan rates for HCPCS Q4173

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $407.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $363.08 / $3,235.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $363.08 / $1,479.11
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $363.08 / $676.08