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New Jersey rates for HCPCS Q4256

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.05 / $735.05 / $735.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $742.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.44 / $735.05 / $735.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.05 / $735.05 / $832.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.11 / $735.05 / $1,090.43
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,702.00 / $13,785.00 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.02 / $935.02 / $1,356.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.76 / $735.05 / $808.56