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New York rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $31.74 / $6,800.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $64.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $76.91
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.44 / $30.44 / $31.96
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.44 / $30.44 / $30.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $30.23 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $42.78
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $42.78 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.37 / $32.79 / $37.82
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $31.37
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $31.37 / $31.37
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.36 / $121.36 / $121.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $32.32 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $54.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $47.18
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.37 / $31.37 / $33.15
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $31.37 / $31.37