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Michigan rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,068.94 / $3,068.94 / $3,068.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,068.94 / $3,068.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,068.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,575.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,901.66 / $4,352.49 / $4,469.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,161.31