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Arkansas rates for HCPCS Q4103

Oasis burn matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.99 / $14.99 / $14.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.12 / $14.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.43 / $13.43 / $13.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.43 / $13.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.78 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.24 / $12.49 / $14.24