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Oregon rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.85 / $48.85 / $48.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $135.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.77 / $68.56 / $103.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $62.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.76 / $119.11 / $138.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.85 / $52.75 / $111.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $55.92 / $65.94
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.29 / $52.75 / $109.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $58.03 / $111.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $57.56 / $62.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.53 / $195.53 / $195.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.11 / $52.75 / $52.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $60.66