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Arkansas rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,353.19 / $2,353.19 / $2,353.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,059.05 / $2,353.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,127.50 / $2,127.50 / $2,127.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,090.00 / $2,127.50 / $2,127.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,127.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,804.12 / $1,961.00 / $2,164.89