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Texas rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $134.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $114.82 / $239.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $128.82 / $229.09
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
$151.36 / $151.36 / $524.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $120.23 / $398.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $177.83 / $812.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $125.89 / $125.89