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Arizona rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.09 / $145.09 / $145.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $134.54 / $145.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.78 / $254.64 / $629.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.47 / $134.72 / $318.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.43 / $131.90 / $131.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.40 / $167.28 / $318.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.86 / $142.86 / $310.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90