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Arizona rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.92 / $202.26 / $202.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $81.92 / $85.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.66 / $176.39 / $436.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.83 / $93.33 / $220.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.92 / $92.59 / $166.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $296.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $136.47