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Arizona rates for HCPCS Q4254

Novafix DL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $391.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.98 / $678.00 / $1,676.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.47 / $358.73 / $847.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $542.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,041.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00