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Arizona rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.70 / $78.70 / $78.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $72.27 / $78.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.70 / $136.31 / $337.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.60 / $72.12 / $170.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.90 / $82.65 / $159.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $155.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55