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North Carolina 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
$1,007.00 / $1,007.00 / $1,007.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $1,007.00 / $1,007.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$825.57 / $889.37 / $978.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,009.67
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.00 / $1,007.00 / $1,749.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.00 / $798.00 / $1,638.43
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.30 / $1,324.30 / $1,324.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,189.82 / $1,189.82 / $1,609.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,020.31
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,351.50 / $1,812.38 / $5,654.61
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,654.61 / $5,654.61 / $5,654.61