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Maryland rates for HCPCS Q4254

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $355.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $391.46
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.00 / $622.00 / $669.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.70 / $480.00 / $504.24