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Tennessee rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $188.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $107.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $110.97 / $206.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.44 / $515.50 / $774.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.40 / $784.32 / $928.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $100.17