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Oregon rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $565.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.99 / $490.53 / $986.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $574.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.36 / $1,003.99 / $1,191.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $1,078.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $516.84 / $609.49
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.99 / $543.20 / $1,274.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.30 / $490.53 / $1,078.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.30 / $640.57 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.21 / $487.59 / $487.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $560.73