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Arizona rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.34 / $536.34 / $536.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $492.46 / $536.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.80 / $939.80 / $2,324.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.01 / $497.25 / $1,174.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.28 / $570.34 / $1,088.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $1,058.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59