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Arkansas rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,258.93
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $691.83 / $1,000.00