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Oregon rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $2,901.66 / $2,901.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,456.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,810.90 / $5,726.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $3,373.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $6,371.35 / $7,380.62
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $2,979.56 / $6,376.26
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,158.33 / $3,873.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,895.23 / $2,979.56 / $6,183.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $3,135.00 / $6,406.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $3,562.50 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,830.58 / $2,979.56 / $2,979.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,426.49