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Texas rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $30,199.52 / $93,325.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $30.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $81.28 / $158.49
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $229.09 / $12,302.69
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
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
$134.90 / $134.90 / $134.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $30.90 / $20,417.38
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.70 / $223.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $57.54 / $66.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $30.90 / $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
$30.90 / $83.18 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $125.89 / $125.89