go back

Arizona rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.46 / $61.36 / $3,451.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.53 / $33.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.48 / $57.83 / $143.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.86 / $30.60 / $72.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $36.65 / $67.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $65.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23