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New Jersey rates for HCPCS Q4201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $76.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.09 / $199.34 / $257.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.09 / $76.09 / $86.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.78 / $76.09 / $112.87
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,702.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.35 / $112.67 / $172.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.98 / $76.09 / $83.70