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Tennessee rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.87 / $12.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.60 / $8.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
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
$32.39 / $32.39 / $32.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $7.87 / $7.87