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New York rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $85.11
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $537.03 / $1,445.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $831.76 / $977.24
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $79.43
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $79.43 / $79.43
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $954.99
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $83.18
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $79.43 / $79.43