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New York rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $13.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $21.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.86 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $16.78
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $18.20 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.79
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $13.35
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.35 / $13.35
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $20.75 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $17.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $18.96
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.35 / $13.35 / $13.35
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.35 / $13.35