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New Jersey rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $6,310 · 10th–90th $219–$25,1190%5%10th90th$6,310Professionalmedian $1,230 · 10th–90th $135–$1,3490%20%40%10th90th$1,230$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $1,445.44 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $1,202.26 / $1,412.54
Horizon BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $11,481.54 / $26,302.68
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $2,041.74 / $2,041.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $141.25 / $1,318.26