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Tennessee rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $227.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $130.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.25 / $141.31 / $332.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$474.00 / $1,606.18 / $1,606.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,606.18 / $1,606.18 / $1,606.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15