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Oregon rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $66.31 / $66.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $78.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.47 / $106.77 / $127.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $79.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.38 / $161.69 / $215.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $67.27 / $228.17
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $71.31 / $87.45
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $69.81 / $898.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $80.72 / $228.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $97.75 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.91 / $67.27 / $67.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $77.36