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Indiana 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 / $377.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $686.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $491.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.41 / $64.41 / $99.83
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.41 / $64.41 / $77.29
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $514.08