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Tennessee rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $53.03 / $10,837.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $33.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $31.16 / $34.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $134.55 / $134.55
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,212.73 / $2,212.73 / $2,212.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23