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Arizona rates for HCPCS Q4219

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,000.00 / $1,023.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $141.25 / $346.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $144.54 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,071.52 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $794.33 / $794.33