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New York rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $62.41 / $63.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $64.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $93.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $62.41 / $89.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $67.70
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $88.32 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.82 / $62.41 / $101.86
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $64.77
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $64.77 / $64.77
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $87.93 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $102.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $95.49
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.77 / $64.77 / $64.77
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $64.77 / $64.77