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Arkansas rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$787.35 / $787.35 / $787.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $688.93 / $787.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,182.63 / $1,182.63 / $1,182.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.02 / $1,182.63 / $1,182.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $711.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.63 / $656.12 / $747.98