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Wisconsin rates for HCPCS Q4259

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

Facilitymedian $977 · 10th–90th $708$3,6310%20%10th90th$977Professionalmedian $724 · 10th–90th $178$2,1880%50%10th90th$724$5.0$20.0$100.0$500.0$2.0K$10.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $776.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $3,019.95 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $2,691.53 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $1,230.27 / $1,949.84
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $741.31 / $1,621.81
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $977.24 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $1,995.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,348.96
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,348.96 / $2,187.76
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $275.42 / $549.54
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $1,348.96 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $812.83 / $5,623.41
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $1,174.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $2,290.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $977.24