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Texas rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $93 · 10th–90th $63$7080%20%10th90th$93Professionalmedian $63 · 10th–90th $62$1260%20%10th90th$63$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$61.66 / $61.66 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $74.13
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $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
$63.10 / $66.07 / $147.91
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $67.61 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $58.88 / $61.66
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $67.61 / $181.97
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
$67.61 / $102.33 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89