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Texas rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $984.00 / $984.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $984.00 / $1,020.00
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.00 / $2,400.00 / $4,500.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,560.00 / $4,560.00 / $5,400.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$979.20 / $1,200.00 / $2,086.08
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.10 / $205.54 / $302.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$979.20 / $1,200.00 / $2,086.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $799.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.84 / $100.84 / $136.13