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North Carolina 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 / $373.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $60.00 / $700.19
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.84 / $329.84 / $528.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.84 / $329.84 / $329.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.00 / $192.00 / $480.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $624.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.00 / $720.00 / $960.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,824.00 / $1,824.00 / $2,160.00