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Michigan rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $80.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $100.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $80.00 / $85.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $173.44