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Arizona rates for HCPCS Q4209

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.47 / $327.16 / $809.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.63 / $173.10 / $408.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $385.00 / $740.59