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Texas rates for HCPCS Q4116

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

Facilitymedian $933 · 10th–90th $31–$69,1830%5%10%10th90th$933Professionalmedian $26 · 10th–90th $24–$1260%50%10th90th$26$2.0$20.0$200.0$2.0K$20.0K$200.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $30,199.52 / $93,325.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $25.12 / $30.90
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $81.28 / $158.49
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33,884.42 / $33,884.42 / $41,686.94
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $30.90 / $11,220.18
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $26.92 / $223.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $60.26 / $66.07
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.70 / $30.90 / $151.36
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89