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Oregon rates for HCPCS Q4253

Zenith Amniotic Membrane Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $87.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $143.00 / $169.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $89.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.99 / $202.73 / $341.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $83.18 / $1,254.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $87.16 / $98.53
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $85.80 / $253.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $103.83 / $1,254.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $163.62 / $2,250,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $75.79 / $75.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $87.16