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Arizona rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,631.00 / $19,198.77 / $58,368.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $25.20 / $26.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.09 / $59.27 / $146.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.48 / $31.36 / $74.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.20 / $30.98 / $60.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11