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Michigan rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,802.91 / $3,802.91 / $3,802.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,802.91 / $3,802.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,228.34 / $3,692.14 / $3,692.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,802.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $4,430.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $4,393.53 / $5,662.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,917.36