go back

Rhode Island rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $281.84 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $93.33 / $125.89