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New York rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $730.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $681.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.75 / $655.29 / $1,191.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $1,537.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $655.29 / $1,390.97
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.01 / $655.29 / $1,168.42
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $680.03
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $680.03 / $680.03
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $618.21 / $1,537.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $927.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $982.95
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.03 / $680.03 / $680.03
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $680.03 / $680.03