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Arizona rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,061.36 / $4,061.36 / $4,061.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,729.06 / $4,061.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,361.96 / $5,580.15 / $13,799.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.87 / $2,952.46 / $6,975.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,680.47 / $4,152.25 / $8,429.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,774.77 / $3,774.77 / $8,191.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $5,169.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14