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Pennsylvania 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 / $720.64 / $2,485.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $720.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.48 / $713.50 / $1,070.25
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50
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 / $774.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.48 / $713.50 / $911.39
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $950.87 / $2,485.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $950.87
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $713.50 / $713.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $908.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $1,070.25