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Pennsylvania 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
$371.54 / $371.54 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $354.81 / $389.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $407.38 / $407.38
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $158.49 / $208.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $389.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $354.81 / $389.05
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $194.98 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $380.19 / $478.63