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Texas 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 / $384.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $384.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.03 / $175.03 / $175.03
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.00 / $960.00 / $1,800.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,824.00 / $1,824.00 / $2,160.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $754.47
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.10 / $205.54 / $302.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $754.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $480.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $480.44