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New Jersey rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.60 / $173.93 / $178.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.41 / $178.13 / $195.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.41 / $178.13 / $178.13
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.66 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.51 / $163.51 / $163.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $214.38