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Tennessee rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.00 / $996.00 / $1,743.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $996.00 / $1,020.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.00 / $1,144.80 / $1,242.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.00 / $2,400.00 / $4,500.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,560.00 / $4,560.00 / $5,400.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.54 / $788.99 / $788.99