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New York rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.89 / $13,286.75 / $47,383.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.47 / $25.82 / $26.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.18 / $31.11 / $66.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $36.69
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $44.03 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $33.75 / $35.78
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.07 / $34.15 / $34.42
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.33 / $316.00 / $611.01
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.04 / $85.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $55.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $43.60
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.15 / $34.15 / $34.42
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.15 / $34.15 / $34.42