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Rhode Island rates for HCPCS Q4133

Grafix Prime Grafixpl Prime Stravix And Stravixpl Per Square Centimeter (Desc Rvsd 1/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.29 / $144.29 / $144.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $144.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.85 / $321.07 / $356.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74