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Tennessee rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.82 / $147.82 / $258.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.82 / $181.20 / $250.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.72 / $1,392.99 / $1,443.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,351.44 / $1,351.44 / $2,226.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.84 / $254.57 / $254.57