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Arkansas rates for HCPCS Q4205

Membrane Graft Or Membrane Wrap Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.74 / $1,484.74 / $1,484.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,299.15 / $1,484.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.52 / $1,291.52 / $1,291.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.82 / $1,291.52 / $1,291.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.25 / $1,237.28 / $1,237.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.28 / $1,237.28 / $1,342.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,113.55 / $1,237.28 / $1,410.50