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Arizona rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.91 / $148.91 / $148.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.21 / $148.91 / $253.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.47 / $327.16 / $809.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.63 / $173.10 / $408.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.91 / $223.38 / $486.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $552.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $254.57