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Oregon rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $12.38 / $12.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $17.66 / $25.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.36 / $29.98 / $36.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.16 / $12.49 / $23.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.24 / $16.11
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $12.49 / $25.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $15.60 / $24.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $15.75 / $15.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.87 / $12.49 / $12.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.36