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Missouri 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
$727.77 / $1,669.50 / $1,669.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $727.77 / $856.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$990.03 / $1,219.13 / $1,640.10
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 / $908.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.29 / $1,140.00 / $2,333.50
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.46 / $941.46 / $5,654.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,305.86 / $1,305.86 / $1,748.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $872.61