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New York rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.87 / $7.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.52 / $7.87 / $15.84
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.99 / $6.99 / $7.34
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.99 / $6.99 / $6.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.60 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.14
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.88 / $11.15 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.88 / $8.53 / $9.06
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.17
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.17 / $8.17
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.87 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $13.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.60
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.99 / $8.17 / $8.17
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.17 / $8.17