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Arizona rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,023.29 / $2,511.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $831.76 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $724.44 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,174.90 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $724.44 / $1,000.00