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Arizona rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,157.10 / $2,157.10 / $2,157.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,980.61 / $2,157.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,624.09 / $3,836.91 / $9,488.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,649.47 / $2,030.11 / $4,796.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.82 / $2,274.76 / $4,378.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $4,255.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00