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Tennessee rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,278.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $720.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$730.44 / $792.45 / $940.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.50 / $4,487.09 / $5,146.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,487.09 / $5,361.66 / $5,727.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29