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Arkansas rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,575.47 / $3,575.47 / $3,575.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,128.53 / $3,575.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $3,091.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,681.60 / $2,979.56 / $3,039.15