go back

Oregon rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $1,445.44 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $812.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $263.03 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $660.69 / $1,000.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $251.19 / $537.03
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $691.83 / $1,737.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $1,659.59
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
$125.89 / $158.49 / $1,737.80