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New Jersey rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $105.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.78 / $83.94 / $85.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.70 / $88.46 / $101.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.59 / $100.45 / $101.13
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.93 / $8,702.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.95 / $85.95 / $85.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $143.97