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Michigan rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,288 · 10th–90th $102–$1,9050%20%40%10th90th$1,288Professionalmedian $1,230 · 10th–90th $398–$1,3490%20%40%10th90th$1,230$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,148.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $1,778.28 / $4,786.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $1,288.25 / $2,290.87
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
$102.33 / $102.33 / $1,737.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13