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New York rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $144.54 / $38,018.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $100.00 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $194.98 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $158.49 / $338.84
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $208.93
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $117.49 / $117.49
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $117.49
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $125.89 / $154.88
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $117.49 / $117.49
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $117.49