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Rhode Island rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $281.84 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $251.19