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Tennessee rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.82 / $912.12 / $55,334.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.89 / $25.82 / $26.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $31.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.12 / $136.12 / $136.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.55 / $31.11 / $31.11