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Oregon rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $12.02 / $31.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $16.98 / $23.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $14.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $245.47 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $14.13 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $239.88 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $17.78
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $13.49 / $147.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $79.43 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $125.89 / $125.89