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Oregon rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $89.18 / $1,532.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $397.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.66 / $193.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $125.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.45 / $217.72 / $391.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $106.70 / $229.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $113.10 / $138.71
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $106.70 / $266.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $139.78 / $302.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $188.91 / $259.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.37 / $106.70 / $106.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $122.71