go back

New Mexico 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 / $720.64 / $906.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.26 / $1,589.67 / $1,589.67
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $713.50 / $906.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,600.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.26 / $975.26 / $975.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50