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Michigan rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,028.98 / $2,028.98 / $2,028.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,028.98 / $2,028.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.20 / $1,969.89 / $2,028.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,363.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,968.50 / $2,659.35 / $2,954.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,090.05