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Oregon rates for HCPCS Q4194

Novachor, 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 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,202.26 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $776.25
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 / $954.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $380.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $691.83 / $1,096.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $1,096.48
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 / $1,000.00