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Arizona rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.70 / $83.70 / $83.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.84 / $83.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.63 / $164.51 / $406.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.72 / $87.04 / $205.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.27 / $92.72 / $184.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.23 / $79.23 / $171.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.47 / $142.47 / $142.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09