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New York rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.01 / $38.20 / $2,682.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.01 / $37.29 / $38.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.47 / $44.94 / $88.77
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.97 / $31.97 / $33.57
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.97 / $31.97 / $31.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.65 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $58.05
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.52 / $56.83 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $51.68
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.61 / $40.61 / $40.61
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.27 / $42.37 / $45.08
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.65 / $85.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $58.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $71.38
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.61 / $40.61 / $42.37
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.27 / $42.27 / $42.37