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Michigan rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $7,762.47 / $48,977.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $30.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $20.42 / $32.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $32.36 / $33.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $39.81
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $75.86 / $38,018.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $30.20 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $33.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $33.11 / $125.89