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Arizona rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.76 / $24.11 / $207.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.12 / $13.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.68 / $22.87 / $56.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.83 / $12.10 / $28.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $13.51 / $25.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $11.70 / $25.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88