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Alaska rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.11 / $1,327.11 / $1,327.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,009.67
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.46 / $1,327.11 / $1,857.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $927.55
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,933.18 / $2,544.00 / $3,498.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.23 / $1,749.00 / $1,908.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $1,327.11 / $2,280.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $1,368.00 / $1,612.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.25 / $1,070.25 / $2,140.50