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Arizona rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.55 / $808.55 / $808.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $742.40 / $808.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.00 / $1,781.33 / $4,405.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.78 / $942.50 / $2,226.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$792.86 / $983.99 / $1,887.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.21 / $813.21 / $1,764.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05