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Arizona rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.66 / $8.66 / $8.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.02 / $8.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.13 / $14.48 / $35.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.23 / $7.66 / $18.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $8.61 / $15.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $15.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87