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Michigan rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.47 / $1,084.47 / $1,084.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,084.47 / $1,084.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.30 / $375.52 / $769.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.68 / $922.51 / $1,197.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.20 / $1,052.89 / $1,052.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.60 / $1,052.89 / $1,084.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,263.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $450.27 / $1,579.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,117.11