Novafix DL tissue product, per square centimeter

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Novafix dl per sq cm

Payers reporting HCPCS Q4254

Payer pricing summary

Low

$68

Average

$269

Median

$205

High

$905

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +9 other terms	295	$210	$250	$139	56%	—	$48 – $683
2	Cigna fee schedule · outpatient · +7 other terms	214	$612	$1.1k	$945	89%	—	$119 – $3.5k
3	Aetna fee schedule · outpatient · +9 other terms	169	$140	$293	$429	146%	—	$69 – $4.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +7 other terms	143	$237	$279	$163	58%	—	$1 – $1.4k
5	Humana fee schedule · outpatient · +5 other terms	92	$126	$225	$294	131%	—	$48 – $1.3k
6	Molina facility · fee schedule · outpatient · +6 other terms	48	$126	$145	$121	83%	—	$65 – $1.1k
7	WellCare fee schedule · outpatient · +4 other terms	46	$136	$139	$14	10%	—	$115 – $171
8	Anthem facility · fee schedule · outpatient · +4 other terms	35	$118	$213	$221	104%	—	$48 – $1.2k
9	Ambetter fee schedule · outpatient · +2 other terms	33	$234	$246	$45	18%	—	$162 – $351
10	Devoted fee schedule · outpatient · +3 other terms	33	$125	$125	$7	6%	—	$116 – $136
11	Optum fee schedule · outpatient · +1 other terms	32	$125	$173	$91	53%	—	$113 – $459
12	Kaiser fee schedule · outpatient · +3 other terms	31	$180	$286	$223	78%	—	$125 – $1000
13	Bcbs Tx fee schedule · outpatient	30	$244	$252	$79	31%	—	$186 – $919
14	Caresource fee schedule · outpatient · +2 other terms	24	$100	$94	$65	69%	—	$48 – $213
15	Oscar facility · fee schedule · outpatient · +1 other terms	19	$182	$196	$25	13%	—	$175 – $234
16	Medicare fee schedule · outpatient	18	$125	$125	—	—	—	$125 – $125
17	Highmark fee schedule · outpatient · +4 other terms	16	$449	$471	$299	63%	—	$127 – $3.4k
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	14	$118	$150	$96	64%	—	$64 – $468
19	Bcbs Nj fee schedule · outpatient	12	$398	$398	—	—	—	$398 – $398
20	Tricare fee schedule · outpatient · +1 other terms	11	$113	$118	$10	8%	—	$113 – $148
21	Medica fee schedule · outpatient · +4 other terms	10	$1.0k	$1.0k	$252	25%	—	$608 – $1.3k
22	Regence fee schedule · outpatient · +4 other terms	10	$146	$146	$4	3%	—	$140 – $156
23	Bcbs Mn fee schedule · both · +2 other terms	8	$412	$411	$4	1%	—	$408 – $415
24	Clover facility · fee schedule · outpatient · +1 other terms	8	$123	$123	$6	5%	—	$117 – $134
25	Excellus fee schedule · outpatient · +2 other terms	6	$236	$230	$60	26%	—	$127 – $351

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