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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
$1,263.46 / $1,263.46 / $1,263.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,105.53 / $1,263.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.36 / $945.36 / $945.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.51 / $945.36 / $945.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,092.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.60 / $1,052.89 / $1,073.95