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Tennessee rates for HCPCS Q4104

Integra bilayer matrix wound dressing (BMWD), per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $94.08 / $21,322.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $53.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $54.02 / $60.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.00 / $51.00 / $51.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $231.33 / $231.33
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.33 / $231.33 / $231.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.45 / $51.00 / $51.00