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Michigan rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,047.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,511.89 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $758.58 / $2,951.21
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $933.25 / $1,862.09