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Tennessee rates for HCPCS Q4253

Zenith Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $145.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.50 / $83.18 / $94.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.00 / $1,140.00 / $1,140.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.00 / $1,311.00 / $1,311.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.52 / $75.79 / $75.79