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Arizona rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.73 / $195.88 / $195.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $99.90 / $107.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.78 / $190.83 / $471.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.04 / $100.97 / $238.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.40 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.34 / $130.58 / $216.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.92 / $107.92 / $234.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $100.17