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Oregon rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.48 / $2.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $14.46 / $18.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.12 / $6.32 / $29.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.74 / $15.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.64 / $3.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.74 / $7.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $5.35 / $16.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $11.13 / $13.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.49 / $2.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.86