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New Jersey rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $645.65 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $602.56
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $1,122.02 / $1,318.26
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $11,481.54 / $25,118.86
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,398.83 / $2,818.38