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Montana rates for HCPCS Q4254

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

Facilitymedian $355 · 10th–90th $138–$4790%20%10th90th$355Professionalmedian $355 · 10th–90th $115–$4070%20%40%10th90th$355$50.0$100.0$200.0$500.0

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
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $354.81 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $204.17 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $407.38
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $354.81 / $478.63
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $389.05
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89