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Arizona rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,277.51 / $3,277.51 / $3,277.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,009.35 / $3,277.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,443.02 / $3,409.13 / $8,430.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.90 / $2,886.03 / $6,818.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,829.26 / $3,365.92 / $6,479.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,901.66 / $2,901.66 / $6,296.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56