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Tennessee rates for HCPCS Q4142

XCM biologic tissue matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $195 · 10th–90th $102–$7080%20%10th90th$195Professionalmedian $117 · 10th–90th $76–$1350%20%10th90th$117$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $102.33 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $186.21 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $125.89 / $125.89