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Tennessee rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $138.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.22 / $85.95 / $93.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.18 / $375.43 / $671.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.97 / $408.74 / $1,274.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.35 / $142.47 / $185.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09