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Texas rates for HCPCS Q4111

GammaGraft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.91
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.94 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $33.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $8.13 / $120.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.94 / $223.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.41 / $32.36
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $13.49 / $15.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.76 / $8.13 / $144.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $83.18 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $125.89 / $125.89