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Tennessee rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.81 / $23.81 / $41.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $23.81 / $24.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $33.45 / $36.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $85.00 / $107.59
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.02 / $109.02 / $129.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $28.69 / $28.69