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Michigan rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,470.27 / $1,470.27 / $1,470.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,470.27 / $1,470.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $2,115.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,470.27
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,712.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.73 / $1,570.19 / $2,467.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,538.51