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New Jersey rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,063.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.36 / $336.94 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.29 / $1,052.89 / $1,344.91
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.18 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.62 / $300.18 / $300.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.27 / $1,052.89 / $1,110.80