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Tennessee rates for HCPCS Q4211

Amnion Bio or AxoBioMembrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $102.33 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $114.82 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $125.89 / $125.89