go back

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
Facility
Modifier
Low / Median / High Price
$73.52 / $73.52 / $73.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $73.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $35.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70