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Arizona rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $426.58 / $1,047.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $436.52 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,000.00 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $302.00 / $1,000.00