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New Jersey rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,729.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.00 / $594.00 / $3,692.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,692.14
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,483.15 / $3,692.14 / $4,716.18
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,165.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,907.00 / $2,907.00 / $2,907.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,692.14 / $3,692.14 / $3,895.21