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Texas rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $16,133.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
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
$1,355.61 / $1,355.61 / $1,449.86
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $394.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.24 / $148.10 / $302.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $394.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $1,800,000.00 / $2,250,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.21 / $40.21 / $54.28