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New Jersey rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.24 / $10.66 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $16.50
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.53 / $8,702.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.53 / $12.53 / $12.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.27