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Arizona rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.77 / $77.77 / $77.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $71.40 / $77.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.30 / $140.09 / $346.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.22 / $74.12 / $175.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.38 / $83.26 / $165.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $154.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70