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Arkansas rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,430.57 / $4,430.57 / $4,430.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,876.75 / $4,430.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,095.28 / $4,095.28 / $4,095.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,039.55 / $4,095.28 / $4,095.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,483.15 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,831.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,322.93 / $3,692.14 / $3,765.98