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Arkansas rates for HCPCS Q4239

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,283.15 / $2,283.15 / $2,283.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,997.75 / $2,283.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,211.59 / $2,211.59 / $2,211.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,211.59 / $2,211.59 / $2,438.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.93 / $1,902.62 / $1,902.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,064.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.49 / $1,902.62 / $2,146.85