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Arkansas rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,363.86 / $2,363.86 / $2,363.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,068.38 / $2,363.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,941.49 / $1,941.49 / $1,941.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.49 / $1,941.49 / $2,251.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.38 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,137.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,871.40 / $1,969.89 / $2,245.67