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Arkansas rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.20 / $856.20 / $856.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $749.18 / $856.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,021.40 / $1,021.40 / $1,021.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,012.06 / $1,021.40 / $1,021.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $774.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.83 / $713.50 / $813.39