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Oregon rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $83.18 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $173.78 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $245.47 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $102.33 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $239.88 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $144.54 / $144.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $100.00 / $204.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $151.36
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
$125.89 / $138.04 / $138.04