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Tennessee rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $125.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $75.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $77.63 / $101.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.18 / $202.50 / $390.68
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.63 / $395.88 / $468.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.40 / $71.55 / $71.55