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Arizona rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
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
$5,120.10 / $5,632.12 / $10,833.95