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Tennessee rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,431.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,059.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $2,127.50 / $2,349.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.50 / $5,700.00 / $6,562.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,720.00 / $7,505.00 / $8,550.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00