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New York rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $71.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $73.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $168.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $255.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $100.04 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.02 / $70.70 / $126.04
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $73.36
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $73.36 / $73.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $255.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $83.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $110.34
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.36 / $73.36 / $73.36
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $73.36 / $73.36