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New York rates for HCPCS Q4249

AMNIPLY, for topical use only, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $1,969.89 / $1,989.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,048.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.96 / $1,773.27 / $1,969.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.03 / $1,858.38 / $2,296.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $1,969.89 / $4,181.35
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,674.41 / $1,969.89 / $2,044.22
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,044.22
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,044.22 / $2,044.22
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.03 / $1,858.38 / $2,296.02
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,954.84
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,044.22 / $2,044.22 / $2,044.22
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $2,044.22 / $2,044.22