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California 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
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $720.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $784.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.70 / $1,092.47 / $1,848.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $994.75 / $2,653.40
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $1,387.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $673.11 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $875.05
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.74 / $1,408.81 / $1,728.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.15 / $891.88 / $1,616.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,351.50 / $1,812.38 / $5,654.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,654.61 / $5,654.61 / $5,654.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.81 / $1,728.99 / $2,625.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $784.85 / $1,279.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,590.00
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.79 / $1,280.74 / $1,536.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,519.61