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New Jersey rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $89.13 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $77.62
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $831.76 / $977.24
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $11,481.54 / $25,118.86
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $125.89 / $954.99