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Oregon rates for HCPCS Q4107

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

Facilitymedian $145 · 10th–90th $93$1450%50%10th$145Professionalmedian $85 · 10th–90th $79$2570%20%40%10th90th$85$20.0$200.0$2.0K$20.0K$200.0K$2.0M

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
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$83.18
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$107.15
Typical High
$181.97
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$239.88
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$144.54
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$204.17
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$125.89
Typical High
$158.49
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89