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Arizona rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.82 / $130.82 / $2,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $66.70 / $71.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.74 / $124.59 / $308.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.56 / $65.92 / $155.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.70 / $65.40 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.92 / $71.95 / $111.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $360.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41