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Tennessee rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $63.10 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $61.66 / $74.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $371.54 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $83.18 / $125.89