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Texas rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.00 / $155.80 / $155.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.00 / $155.80 / $161.50
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.50 / $380.00 / $712.50
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.00 / $722.00 / $855.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $65.92 / $330.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.51 / $148.10 / $302.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $152.00 / $330.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $167.51 / $167.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.92 / $65.92 / $88.99