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Oklahoma rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.65 / $45.90 / $11,132.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.53 / $32.65 / $32.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $28.52 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.71 / $34.36 / $54.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $30.30 / $2,212.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $33.49