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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
$370.11 / $391.46 / $391.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $370.11 / $391.46
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.11 / $398.40 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.40 / $398.40 / $398.40
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.80 / $408.00 / $408.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.11 / $370.11 / $391.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $370.11 / $391.46
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.00 / $480.00 / $626.40