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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
$707.95 / $741.31 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $851.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $120.23 / $1,288.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $194.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $831.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $933.25 / $5,623.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $977.24 / $1,318.26