go back

Washington 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
$391.46 / $391.46 / $391.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $391.46 / $391.46
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.40 / $456.00 / $1,800.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $1,824.00 / $2,160.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $816.00
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
$12.79 / $12.79 / $12.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.40 / $398.40 / $408.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.60 / $408.00 / $432.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $576.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $355.88