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Arizona rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.90 / $153.90 / $153.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.00 / $153.90 / $157.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.90 / $304.52 / $753.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.91 / $161.12 / $380.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $157.69 / $312.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $167.51 / $363.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $167.51 / $167.51