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New York rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $2,979.56 / $3,009.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,098.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,810.90 / $2,863.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $2,979.55 / $6,324.53
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,532.62 / $2,979.55 / $2,979.55
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,091.99
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,091.99 / $3,091.99
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $2,810.90 / $2,863.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $3,034.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $4,571.84
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,091.99 / $3,091.99 / $3,091.99
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,091.99 / $3,091.99