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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)

Facilitymedian $3 · 10th–90th $2–$120%50%10th90th$3Professionalmedian $10 · 10th–90th $2–$2570%20%40%10th90th$10$2.0$20.0$200.0$2.0K$20.0K$200.0K$2.0M

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $10.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $18.20 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $257.04 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $3.55 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $239.88 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $2.51 / $3.72
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $3.39 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $79.43 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89