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New York rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $131.83
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $537.03 / $1,230.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $707.95 / $831.76
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $117.49
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $117.49 / $117.49
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $812.83
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $123.03
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $117.49 / $117.49