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Arkansas rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.49 / $166.49 / $1,699.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $145.68 / $174.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.74 / $147.74 / $147.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.51 / $147.74 / $147.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $150.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.87 / $138.74 / $158.16