go back

New York rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $11.88 / $12.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $23.27
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.80 / $9.80 / $10.29
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $9.80 / $9.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.95 / $11.21 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.68
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $16.82 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.33 / $12.89 / $14.82
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.33
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.33 / $12.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.95 / $11.88 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $15.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $17.52
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.59 / $12.33 / $12.33
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.33 / $12.33