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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
$1,158.18 / $1,158.18 / $1,158.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,063.42 / $1,158.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.06 / $571.88 / $1,414.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.85 / $302.58 / $714.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$848.30 / $1,010.79 / $2,028.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.37 / $871.37 / $1,325.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89