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Michigan rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $4 · 10th–90th $2–$1020%20%40%10th90th$4Professionalmedian $2 · 10th–90th $2–$180%50%90th$2$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $10.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.40 / $2.34 / $2.34
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.24 / $2.34 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $125.89 / $125.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.72 / $15.14 / $42.66
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $15.85 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $125.89