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New Jersey rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.44 / $9,365.20 / $19,324.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.47 / $25.82 / $26.44
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,025.81 / $21,025.81 / $21,025.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.44 / $31.11 / $34.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $32.29
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $33.75 / $33.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.75 / $33.75 / $33.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $33.00