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Tennessee rates for HCPCS Q4151

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $240.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $141.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.42 / $199.01 / $633.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.20 / $633.20 / $633.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.15 / $134.88 / $134.88