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Arizona rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $151.36 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $151.36 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $120.23 / $229.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $120.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $125.89 / $165.96