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Arizona rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $81.00 / $81.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $81.00 / $85.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.84 / $160.27 / $396.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.90 / $84.80 / $200.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.00 / $94.77 / $164.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $349.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $160.91