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Tennessee rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.94 / $83.94 / $146.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $83.94 / $85.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.02 / $96.48 / $104.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $202.26 / $379.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.00 / $844.00 / $844.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.65 / $136.47 / $136.47