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Michigan rates for HCPCS Q4219

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

Facilitymedian $794 · 10th–90th $102–$9550%20%40%10th90th$794Professionalmedian $977 · 10th–90th $100–$1,0230%20%10th90th$977$100.0$200.0$500.0$1.0K$2.0K

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
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,000.00 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $125.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $117.49 / $346.74
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $158.49 / $1,023.29
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $1,288.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $794.33