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Michigan rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $1,020.00 / $1,020.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.77 / $118.63 / $960.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $960.00 / $1,020.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $837.12