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Oregon rates for HCPCS Q4256

MLG-Complete, 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 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,380.38 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $263.03 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $741.31 / $1,047.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $380.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $812.83 / $1,096.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $758.58 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $125.89 / $1,318.26
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 / $158.49 / $1,862.09