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Texas rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $6,912.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $8,192.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,400,000.00 / $2,400,000.00