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Rhode Island rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.13 / $153.13 / $153.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.13 / $176.02 / $237.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $254.57