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Oregon rates for HCPCS Q4209

SurGraft, 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 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $125.89 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $154.88 / $186.21
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
$120.23 / $141.25 / $302.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $245.47 / $316.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $169.82 / $346.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $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
$125.89 / $125.89 / $125.89