go back

Tennessee rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.43 / $100.43 / $34,627.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $100.43 / $102.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.00 / $128.26 / $139.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.95 / $242.00 / $453.75
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.80 / $459.80 / $544.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.46 / $110.00 / $110.00