go back

Arizona rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $98 · 10th–90th $59–$2880%5%10%10th90th$98Professionalmedian $63 · 10th–90th $62–$1260%20%40%10th90th$63$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $85.11
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $102.33 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $89.13 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $69.18 / $134.90
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $81.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89