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Arizona rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.24 / $23.24 / $23.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.24 / $23.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.64 / $32.22 / $79.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.85 / $17.05 / $40.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $23.81 / $49.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $62.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69