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New Jersey 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
$11.88 / $11.88 / $291.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.90 / $14.89 / $19.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $13.45
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.33 / $12.89 / $15.75
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.01 / $12.01 / $14.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.84