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Tennessee rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $11.88 / $4,065.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.70 / $12.03 / $13.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.16 / $1,591.16 / $1,591.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.47 / $11.88 / $11.88