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Michigan rates for HCPCS Q4187

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.66 / $252.66 / $252.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $252.66 / $267.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.00 / $749.13 / $1,493.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.02 / $76.65 / $99.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $312.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.30 / $252.66 / $337.48
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $294.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.87 / $278.15 / $435.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.30 / $245.30 / $260.26