go back

Oregon rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $117.49 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $100.00 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
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
$100.00 / $120.23 / $154.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $245.47 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $120.23 / $204.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $147.91
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
$109.65 / $125.89 / $125.89