go back

Tennessee rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $124.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $74.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $73.53 / $80.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $320.72 / $344.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $405.09 / $453.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70