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Michigan rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.14 / $31.14 / $4,995.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $31.14 / $31.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.19 / $3,444.07 / $6,895.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.24 / $20.21 / $32.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $39.29
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $88.16 / $8,154.43
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $37.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $34.76 / $54.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $32.07