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Arizona rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,981.07 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $4,073.80 / $6,606.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $3,090.30 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $4,570.88 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,691.53 / $2,818.38