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Arizona rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.74 / $169.74 / $169.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $169.74 / $178.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.16 / $335.85 / $830.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.38 / $177.70 / $419.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.74 / $198.60 / $344.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $440.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $202.90