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Michigan rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.81 / $72.81 / $72.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $71.40 / $72.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $95.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $72.81
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $92.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $95.44 / $110.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $84.84