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Tennessee rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $1,052.89 / $1,524.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,105.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.18 / $871.37 / $986.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$848.30 / $1,400.54 / $1,688.59
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,325.33 / $2,642.15 / $3,476.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.25 / $1,052.89 / $1,052.89