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Rhode Island rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.88 / $12.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $125.89