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Oregon rates for HCPCS A2005

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $199.53 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $223.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $263.03 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $147.91 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $251.19 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $524.81 / $524.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $251.19 / $371.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89