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Arizona rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.00 / $74.00 / $74.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.95 / $74.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.30 / $121.21 / $299.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.10 / $64.13 / $151.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.65 / $80.25 / $154.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.31 / $66.31 / $143.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27