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Oregon rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $26.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $10.47 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $9.33
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
$7.94 / $9.12 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $239.88 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.94 / $11.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $9.12 / $169.82
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.12 / $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
$7.94 / $125.89 / $125.89