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Oregon rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $43.65 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $257.04 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $53.70 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $245.47 / $316.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $53.70 / $181.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $79.43 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $125.89 / $125.89