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Michigan rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,019.83 / $2,019.83 / $2,019.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,019.83 / $2,019.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,565.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,019.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,353.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,215.40 / $3,021.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,113.57