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Michigan rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.21 / $502.21 / $502.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $502.21 / $502.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.96 / $487.59 / $487.59
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $502.21
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $585.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $542.63 / $739.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $525.52