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New York rates for HCPCS Q4124

OASIS ultra tri-layer 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
$2.48 / $2.49 / $2.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $12.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.49 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $11.76
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $3.53 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.49 / $4.30
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.58
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.58 / $2.58
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $13.53 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $14.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.74
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.58 / $2.58 / $2.58
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.58 / $2.58