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Texas rates for HCPCS Q4219

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

Facilitymedian $1,023 · 10th–90th $145$2,6920%20%10th90th$1,023Professionalmedian $977 · 10th–90th $126$1,0230%20%10th90th$977$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
$954.99 / $977.24 / $977.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $977.24 / $1,023.29
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $316.23 / $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
$2,691.53 / $2,691.53 / $2,691.53
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,570.88 / $5,370.32 / $5,370.32
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $1,174.90 / $1,698.24
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $954.99 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $44.67
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $245.47 / $302.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $1,096.48 / $1,659.59
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
$102.33 / $794.33 / $1,288.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $794.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89