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Oregon rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $83.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.50 / $67.50 / $143.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $84.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $159.04 / $182.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.15 / $71.55 / $151.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $82.28 / $93.02
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.60 / $71.55 / $148.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.24 / $71.55 / $114.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.24 / $77.63 / $83.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.97 / $71.55 / $71.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $82.28