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Oregon rates for HCPCS Q4153

Dermavest and Plurivest, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $108.60 / $108.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $148.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.12 / $256.16 / $329.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $162.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.07 / $265.02 / $666.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $137.93 / $295.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $146.19 / $179.31
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.23 / $137.93 / $286.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $172.41 / $296.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $193.23 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.03 / $137.93 / $137.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $158.62