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New York rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $79.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $160.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.78 / $76.09 / $285.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $107.67 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.37 / $76.09 / $135.66
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $78.95
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $78.95 / $78.95
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.78 / $188.39 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $91.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.29 / $76.09 / $116.75
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.95 / $78.95 / $78.95
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $78.95 / $78.95