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Oregon rates for HCPCS Q4233

SurFactor or NuDyn, per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,120.10 / $5,120.10 / $5,120.10
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $175.00 / $194.25
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400,000.00 / $2,400,000.00 / $2,400,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00