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Rhode Island rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $281.84 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $851.14 / $1,000.00