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Arizona rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.01 / $242.00 / $242.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $98.01 / $102.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.09 / $193.93 / $479.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.37 / $102.61 / $242.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.31 / $107.81 / $207.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $238.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00