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Rhode Island rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.04 / $742.04 / $742.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $742.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $35.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50