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New Jersey rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $37.27 / $1,922.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.53
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.70 / $75.70 / $75.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $35.54 / $45.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $34.22
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.37 / $32.79 / $48.97
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.36 / $8,702.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.36 / $30.36 / $33.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $37.04