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Arkansas rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $85.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.48 / $101.12 / $101.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.12 / $101.12 / $101.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $135.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.82 / $136.47 / $140.56