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Kentucky 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 / $713.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $720.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $909.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $998.90 / $1,141.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $784.85 / $1,034.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $1,351.50 / $1,351.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,351.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.26 / $975.26 / $1,267.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $941.46