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Wisconsin rates for HCPCS Q4254

Novafix dl per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $412.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.06 / $564.50 / $1,439.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.30 / $946.36 / $1,341.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.64 / $492.28 / $656.18
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $370.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $456.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,008.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $355.88 / $370.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.73 / $790.60 / $792.02
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $456.00 / $1,800.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $508.80 / $1,824.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.66 / $499.66 / $499.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $576.00