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New York rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.67 / $174.17 / $274.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.82 / $205.60 / $274.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.10 / $95.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.41 / $293.41 / $293.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,999.82 / $2,999.82 / $4,859.71
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,549.85 / $2,999.82 / $2,999.82
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.54 / $585.65 / $585.65
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.54 / $563.54 / $585.65
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.41 / $293.41 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.38 / $216.38 / $216.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.57 / $254.57 / $381.86
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$563.54 / $563.54 / $563.54
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.54 / $563.54 / $585.65