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Oregon rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $20,892.96 / $40,738.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $25.12 / $41.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $36.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $257.04 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $33.11 / $223.87
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $245.47 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $30.90 / $181.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $125.89 / $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
$30.90 / $125.89 / $125.89