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Arizona rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $117.49 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $120.23 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $97.72 / $190.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $91.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $138.04 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $83.18 / $125.89