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Tennessee rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $2,979.56 / $5,077.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,128.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,850.00 / $3,148.02 / $3,323.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,808.51 / $8,103.21 / $9,187.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,975.00 / $10,669.23 / $12,825.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,830.58 / $2,979.56 / $2,979.56