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Virginia 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
$373.67 / $373.67 / $373.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $373.67 / $373.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $512.55
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.00 / $669.00 / $669.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $569.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $620.00 / $620.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.26 / $457.94 / $766.10
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.26 / $457.94 / $766.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $504.00