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New York rates for HCPCS Q4199

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $130.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $115.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $335.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $104.86 / $402.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $111.15
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $157.29 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.86 / $111.15 / $198.19
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.15 / $111.15 / $115.35
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $115.35 / $115.35
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.86 / $402.90 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $359.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $111.15 / $166.73
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.35 / $115.35 / $115.35
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.15 / $115.35 / $115.35