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Tennessee rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $6,605.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,876.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,323.10 / $3,774.78 / $4,273.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,896.15 / $8,289.69 / $12,825.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,970.00 / $12,996.00 / $14,244.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,507.53 / $3,692.14 / $3,692.14