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Montana rates for HCPCS Q4259

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

Facilitymedian $1,072 · 10th–90th $708–$1,3490%20%40%10th90th$1,072Professionalmedian $708 · 10th–90th $166–$1,0000%50%10th90th$708$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $1,122.02
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,071.52 / $1,348.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,071.52 / $1,348.96
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $776.25 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $1,122.02 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89