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Oregon rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.38 / $1,417.38 / $1,417.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,944.00 / $3,054.40 / $3,164.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,424.19 / $2,424.19 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $175.00 / $194.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $3,054.40 / $4,763.34
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.00 / $530.00 / $689.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $530.00 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $3,054.40 / $6,566.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.27 / $1,063.52 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $3,680.00