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Oregon rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $173.93 / $209.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $356.26 / $356.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $175.00 / $194.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.93 / $209.56 / $271.24
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.93 / $209.56 / $271.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $240.46 / $240.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $233.34