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Arizona rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.12 / $43.12 / $43.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $43.12 / $44.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.11 / $85.31 / $210.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.68 / $45.14 / $106.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.58 / $47.43 / $87.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $96.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $44.36