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Michigan rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.88 / $100.88 / $100.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $100.88 / $100.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.38 / $173.58 / $345.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.27 / $101.02 / $131.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.09 / $97.94 / $124.73
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $100.88 / $206.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $122.42
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $124.10 / $176.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $105.56