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Arkansas rates for HCPCS Q4253

Zenith Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.95 / $90.95 / $90.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $79.58 / $90.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.24 / $90.24 / $90.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $90.24 / $90.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $82.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.20 / $75.79 / $86.40