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Arkansas rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.90 / $74.90 / $74.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $65.53 / $74.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.89 / $64.89 / $64.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.89 / $64.89 / $65.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $67.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.29 / $62.41 / $71.15