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Arizona rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.37 / $83.37 / $83.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $76.55 / $83.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.66 / $136.21 / $336.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.56 / $72.06 / $170.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.05 / $100.64 / $193.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $180.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79