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Texas rates for HCPCS A4649

Surgical supply; miscellaneous

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.78 / $6.78 / $550.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $120.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.61 / $49.97 / $204.65
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.80 / $16.80 / $16.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.38 / $3.38 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $2.87 / $2.87
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $760.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $31.98 / $652.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $44.07 / $123.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $3.38 / $120.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.87 / $2.87 / $2.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.77 / $12.77 / $12.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,500.00 / $2,500.00