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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
$7.12 / $7.12 / $7.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $24.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $10.37 / $15.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.27
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.11 / $17.36 / $21.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $8.66 / $16.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.34 / $9.84
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.87 / $16.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $9.16 / $17.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $9.03 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $7.87 / $7.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.05