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Arizona rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,166.88 / $2,166.88 / $2,166.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,989.59 / $2,166.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,832.50 / $4,329.27 / $10,706.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.13 / $2,290.62 / $5,411.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,744.67 / $2,165.35 / $3,996.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,789.55 / $1,789.55 / $3,883.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,757.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89