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Arizona rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.15 / $25.72 / $25.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.99 / $14.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.98 / $23.59 / $58.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.14 / $12.48 / $29.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.19 / $16.88 / $25.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.48 / $14.48 / $17.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86