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Arizona rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,980.80 / $2,980.80 / $2,980.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,944.00 / $2,980.80 / $3,054.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.39 / $1,009.71 / $2,497.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $534.24 / $1,262.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $1,354.70 / $2,741.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $4,991.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $3,200.00