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Oregon 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
$941.46 / $941.46 / $941.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $827.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $1,812.36 / $1,950.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $841.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,578.63 / $2,296.19 / $3,667.22
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $941.46 / $1,749.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $784.85 / $927.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $941.46 / $2,140.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $977.50 / $1,812.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $1,600.93 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.83 / $713.50 / $713.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $820.53